GP Training - Starting at a practice as a GP registrar

It can be a daunting experience, but Dr Linda Miller offers advice on how to start life as GP registrar.

Time spent with the practice nurse can help you understand how chronic conditions are managed (Photograph: Jason Heath Lancy)
Time spent with the practice nurse can help you understand how chronic conditions are managed (Photograph: Jason Heath Lancy)

Starting as a GP registrar in a practice can be daunting but most training practices have a well-planned induction programme, which makes the process smoother.

This should include spending time with different members of staff including the administrative team, the practice manager, receptionists and nurses.

An understanding of the individual practice appointment system, triage, messages and home visit request systems is essential for managing patient demands.

Systems used for handling hospital-generated letters, scanning and processing results, repeat prescription requests and Read coding vary from practice to practice. Some practices only have booked appointments while others have a walk-in system or rely heavily on telephone triage and telephone consultations.

Adjust to primary care
Time spent with the practice nurses is invaluable to understand how chronic diseases are managed in primary care and to familiarise yourself with protocols and QOF points.

It takes time to adjust to taking a focused history rather than a secondary care 'systems enquiry' and you should not be expected to manage 10-minute appointments for some time after you start. Often initial appointments are 30 minutes for new registrars.

Desk top basics
Ensuring your room is well stocked with equipment (see box) and that essential information is accessible will help you keep to time. Make sure your printer is full of plain and prescription paper before each session.

It is also vital that you know where the emergency drugs, defibrillator, oxygen and nebuliser are kept.

Personal safety
It is important to consider personal safety and security wherever you are working. Check where the emergency buzzer is so that you can locate it quickly in an emergency. Also, find out where the buzzer will ring. Some ring in the reception areas and others might also summon help from the police station.

Be aware of your exit route in case a violent situation should arise. If there is no emergency buzzer, some practices have a code word to summon help. This is less satisfactory as it relies on you having the extension numbers for reception and administration and assumes the lines are not engaged.

Contact numbers
A list of numbers for local hospitals, ambulance, local pharmacy, district nurses and health visitors will save you time.

Ensure you have an extension number to call the most IT savvy person in the practice when your computer and printer malfunction as they inevitably will. Have the extension numbers of the other GPs to hand for quick queries.

It is good practice to keep any paperwork in drawers; even practice headed paper can be misused.

Leaving a patient alone in a consultation room while you go in search of a second opinion, potentially leaves blank prescriptions and 'fit notes' unguarded.

Doctors also have a duty to safeguard confidential medical records; patients left alone could access other patients' records on the computer.

Questionnaires show that patients are often seeking information and advice rather than a prescription. Having a good stock of patient leaflets in the room is useful.

However, information sheets from most support organisations can be accessed online and printed out. If the patient is computer literate and the leaflet lengthy, giving them the web address is more environmentally friendly.

It is good practice to use all available resources when you need information. For example, your trainer, other doctors or nurses, text books or online resources (Healthcare Republic, or Clinical Knowledge Summaries).

There are many conditions which are common in primary care but are unlikely to have been encountered in secondary care, such as plantar fasciitis, ringworm and pityriasis versicolor.

Most patients generally appreciate it when you make an extra effort regarding their care, whether it be calling a specialist for advice regarding a complex management problem or searching for more information online.

Reference ranges
It is useful to have some normal values and ranges to hand to refer to during your consultation. Helpful resources include: details of paediatric respiratory and pulse rates and BPs; normal ranges for blood test results; prescription formulary a Read code user guide, a BMI calculator and a gestation calculator.

A good knowledge of and a copy of guidelines is also a useful way of saving time. In particular, make sure you have access to hypertension, diabetes and asthma guidelines.

  • Dr Miller is a GP in west London and mentor for the London deanery
Learning points

1. Get to know all the staff in the practice.

2. Don't be afraid to phone a friend, use online resources and leaflets.

3. Look after your personal safety, prescriptions, certificates and confidential patient records.

4. Don't be afraid to arrange follow-up consultations with patients.

5. Give specific constructive feedback. If a patient says something nice about a receptionist, write it down and pass it on to them.


Essentials check list
  • Sphygmomanometer
  • Stethoscope
  • Auroscope
  • Ophthalmoscope
  • Tongue depressors
  • Thermometer
  • Peak flow meter and mouth pieces
  • Urine pots and dipsticks
  • Swabs
  • Gloves
  • Water-based lubricant
  • Tendon hammer
  • Pregnancy tests
  • Tissues
  • Tape measure
  • Glucometer

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