GPs do not deliver healthcare to their patients in isolation, but work in a variety of teams. The CSA candidate is expected to be familiar with all the roles of the primary healthcare team, and other members of the extended team, such as district and specialist nurses.
How it is covered in the CSA exam
You may come across cases where the patient is a practice manager, receptionist, doctor or nurse. It may not be obviously that the patient is a healthcare professional, so asking the right questions or picking up cues is important.
There may also be cases where a team member is presenting a problem relating to a patient they have been involved in looking after, or perhaps a problem relating to a colleague in the practice.This may not be clinical, and could be related to interpersonal problems, or issues of professionalism or probity.
What to do in the exam
The patient's occupation is often stated in the candidate's briefing notes, so make sure you read these carefully and take this into account.
Knowing that your patient is a doctor or a practice nurse will affect how you take a history, their likely ideas, concerns and expectations, and the terminology you use throughout the consultation.
If the healthcare professional is not coming to you as a patient, establish what the problem is, and be prepared to demonstrate leadership. If presented with a complaint or concern about a colleague, for example, it would not be sufficient simply to refer the problem on immediately to the practice manager.
The GP curriculum explicitly covers management, which includes co-ordinating the work of others in the team, motivating staff, and taking responsibility. Taking responsibility does not mean doing everything yourself, and it is fine to consider bringing the matter to a practice meeting, or involving members of the partnership.
How to prepare
You should be able to co-ordinate a team-based approach to the care of patients so if there are any team members whose roles you are unclear about, find out before the exam. The primary healthcare team is evolving and you may need to think about a range of models of care where team members have different roles to the traditional ones in general practice.
A CSA consultation could be about how GPs and their teams interact with and make use of community services. You should therefore have an awareness of how general practices can work together with social services to benefit patients. The same applies to the out-of-hours situation, as the CSA covers this also.
It is also wise to be clear about your responsibilities as an employer looking after the development and needs of your staff, so find out about some of the health and safety aspects of working in the surgery, as well as grievance and complaints procedures.
- Dr Denney is an MRCGP examiner, and a GP in Edinburgh