Induction Pack

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Index

Welcome About the surgery Induction Your Working Week Home Visits Assessments Causes for Concern SystmOne Referrals Correspondence Investigations Prescribing Read Coding Enhanced Services Quality Outcome Framework Chronic Disease Management Clinics Medical Emergencies Child Protection Policies Complaints Security

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Welcome

Welcome to Ivybridge Medical Practice

In this induction pack is hopefully all the information you will require whilst here for your post, if you feel there is something missing that may be of use please let the Practice Manager or your Trainer know.

We hope you enjoy your time with us!

Best wishes

The team at Ivybridge Medical Practice.

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About the Surgery

We are a 4 partner PMS practiceThe Practice population is generally younger than in many areas of Devon with 12.9% over 65 and 5.61% under 5. Our patients mainly live in Ivybridge with just less than 20% living more than 3 miles away in the surrounding villages of Cornwood, Lutton, Ermington, Ugborough, Bittaford and Lee Mill. We have a branch surgery in Cornwood, which is held monthly. The Practice population of approximately 11,600 is stable and comprises a spread of socio-economic groups.

The practice lies alongside the river, 100 yards from the woods and one mile from the Dartmoor National Park boundary. The original Health Centre was built in 1969 as a single storey building. In 1980 the Health Authority bought the three-storey Victorian House next door and connected it to the Health Centre. In 1988 the Partners bought the buildings from the Health Authority and considerably expanded the premises to include a second storey. In 1999 we completed a further expansion into the two adjacent Victorian houses providing another consulting room, waiting room and offices. Part of the building is rented out for use by a broad team of community staff, and a Pharmacy. We have been a training practice for over 20 years. We hope to relocate to a new site in the near future, to a purpose-built building. This will provide us with more space, and the opportunity to bring some secondary care services from Derriford.Currently we have;

We have 4 partners, 3 full-time(male) and 1 part-time (female) 3 salaried gp’s A team of 4 practice nurses and 3 HCA’s 1 practice manager A full compliment of practice administrators and receptionists We have a wide range of resident or visiting attached community staff including; 2

Physiotherapists, Community nursing team, Health visitors, Midwives, School nurses, Podiatrist, Speech Therapist, CBT, Counsellor, Sonographer and Audiologist.

All of our staff are committed to helping learners and are all very approachable and helpful!

About us

We use SystmOne clinical system Consistently high QOF achievements We offer the full range of primary care services and enhanced services including a minor

injury service

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We have a comprehensive nurse-led system for chronic disease management We hold a weekly operational practice meeting on a Friday lunchtime and a clinical /

educational meeting on a Monday lunchtime, you are welcome to attend all meetings, though sometimes sensitive issues are discussed so we ask for confidentiality to be respected.

We are active members of N. E. W. Devon Clinical Commissioning Group We have a monthly branch surgery in Cornwood. We have a weekly session at Dame Hannah Rogers School.

Induction

Your first weeks in the practice will involve an induction meeting with your trainer, computer training, meeting other key colleagues and a period of observed practice involving ‘sitting in’ with different GP’s. This can be adjusted to meet your learning needs.

Please see separate timetable.

EDUCATIONAL PHILOSOPHY

"We aim to create a supportive learning environment to enable trainees to reach their full potential"

Teaching Time

The teaching and tutorials we provide will depend on your experience and learning needs. Initially we will provide substantial support to review your consultations. We will provide two hours individual [occasionally pairs or larger groups] teaching tutorial time per week. All the partners and the practice manager will be involved in the teaching. We aim to ensure that tutorials ALWAYS happen, barring very unusual circumstances. Please help make the most of this time by:

Keeping your e-portfolio up to date Thinking about the Format and Content Preparing Ahead For Tutorials

There will always be a partner available to support you and you should always feel able to ask for advice.

Contracts

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Below is a link to the Deanery website which links to a standard contract for GP ST registrars;

http://www.peninsuladeanery.nhs.uk/index.php?option=com_content&view=article&id=131&Itemid=238

Study Leave

We encourage all registrars to take the full entitlement of 30 days study leave per year. Some of these are used for the VTS day release teaching, which we, and the Deanery consider an essential part of your training. There are a number of Deanery study days – discuss these with your peers and the trainer. The introductory courses also take up some of this time. Thirty days is not a lot – plan your use of these carefully, bearing in mind your educational needs. Also remember the needs of your examination, and all the other assessments during the year. On a similar note plan your holidays well in advance, this makes it easier for you and the practice to plan ahead. It also avoids burn out during what will be a busy year.

When you are planning study leave make sure it is appropriate within the practice. Almost always it will be, but you are now in a team and cannot assume you won’t be missed.

Commitment

We aim to be an enthusiastic, well-organised practice providing good quality care – and constantly learning from our experiences. This requires commitment from the whole team and we hope you can join with us in that philosophy.

Workload

You will never be asked to do more than any partner. Usually it will be considerably less. The educational process is more important than the service commitment, although the latter is significant and at times may be crucial. Always discuss with your trainer if you feel your workload is too heavy. Toward the end of your GP training you should expect to sample the ‘real’ world, with a workload similar to that of a partner or salaried doctor.

Your Employment

During your placement, you will be employed by the practice. To be able to practice medicine at our practice you must be on the NHS Devon performers list. You should apply for this at least 6 weeks before you start with us!

The practice manager is responsible for making all the necessary employment checks, issuing you with your contract, and making sure you are paid! Please help out by completing all paperwork in good time and passing on your P45 as soon as possible.A link to the appointment form (which should be completed well before joining the practice) and the process of getting everything sorted out is below;http://www.peninsuladeanery.nhs.uk/index.php?option=com_content&view=article&id=1290&Itemid=1188

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We will need to see the originals and take copies of photo ID, passport driving license full GMC registration Medical defence organisation membership Hep B status CRB checkas well some personal contact and employment details, please contact the Practice Manager to arrange this.

Before you start, make sure that all your paperwork is completed for application to the Medical Performer’s List. Despite your best efforts, it actually can take up to 2 months!

Once you’re on the list, contact Devon Doctors to get a username, password and pin number. These are used to access the Devon Doctors rota and book shifts (www.devondoctors.net). In addition, you’ll be provided with an Adastra username and password- this is to log in during a shift. Just e-mail ddocs.gprota@nhs.net or telephone 01392 823156.

You are entitled to a reimbursement of your medical indemnity. To do this, you need to submit an expense claim online and attach a copy of the payment from your medical indemnity provider. If you email expenses.pht@nhs.net, they will be able to set up an account for you.

Parking

Parking is available in the staff car park, at the rear of the building, it can be a squeeze at times though there is plenty of free on-street parking nearby.

The Working WeekAs an ST General Practice registrar, you are contracted for 10 sessions each week;

One of these sessions is for self directed learning, this works best for you and the practice if this is the same session each week, this can be discussed prior to starting or during your induction week.One session is for VTS half day planned teaching (when timetabled see - www.plymouthvts.com), when no teaching is timetabled you will be expected to be seeing patients in the practice as usual. One session is dedicated completely to tutorials / joint surgery / etc.The remaining seven sessions are taken up with patient contact, We would be grateful if you could notify if you plan to take any study time or annual leave while you are with us as early as possible and in any case with a minimum of 6 weeks notice as this is how far ahead our rota runs.

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SurgeriesThe working day begins with morning surgeries beginning at 8.30am and the day generally finishes at 6pm, all doctors offer appointments up to 6pm on 1-2 days of the week. You will usually start at 20-30 minute appointments depending on your experience in General Practice, and reduce to 15 or 10 minutes over time as you develop your skills, knowledge and confidence.

Other learning opportunitiesInclude:

Shadowing other health professionals e.g. MW/HVMinor surgeryIUD’s and contraceptive implants well woman clinicMacmillan nurse/district nurses/community matronsDame Hannah Roger’s School clinic

Supervision

Initially, your supervising GPs will review all patients you see but over time we will move towards end of surgery ‘debriefs’ and /or random checks of clinics. Joint or observed surgeries will also take place regularly.

Home Visits

Due to our semi-rural locality visits can sometimes take up a significant amount of our time. We understand that initially they can be daunting, and can provide a different challenge compared to seeing patients in the practice. GP ST’s doing visits will have a nominated supervisor who will initially jointly visit with you, review after you or discuss with you as required. You will be encouraged to equip your own Doctors bag, this is a useful educational exercise in itself. Your consulting room will be well equipped and these items can be used for visits until you have your own doctors bag organised. We have 2 well-equipped emergency bags and portable oxygen, which are maintained by our nursing team, which can be used for urgent / emergency visits.

Work Place Based AssessmentAs an adult learner you have responsibility for getting your assessments done and for demonstrating your competences. Our practice staff are experienced in helping with these and they we will endeavour to assist you in any way. A guide to requirements can be found following this link;

http://www.drjcope.com/uploads/1/3/1/4/13140168/what_every_trainee_needs_to_know.pdf

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More general information about training can be found here;

http://www.drjcope.com/gp-training.html

Learn to look after yourself, walk away at the end of the day and find some time for your own pleasures. It will be a hectic time but you will learn skills and knowledge that will be invaluable to your long-term career as well as the AKT/ CSA. Use your colleagues and don’t be afraid to ask for help. Take advantage of the many skills of the different doctors and decide early what you would like out of the job.

Keep up-to-date with the e-portfolio (sigh…) and book your Devon Doctors shifts booked soon. Try to get the DOPS/ COTs and CBDs completed early and think about the PSQ halfway through as it will take a couple of weeks to collect 40 questionnaires.

Cause for Concern

Of course when you are uncertain about a clinical case we would wish you to discuss this with your supervising GP, however there is always a risk when ‘you don’t know what you don’t know’.

To help you the following is a list of presentations that initially you should ALWAYS discuss:

Anything which meets or may meet a 2 week referral criteria http://www.nice.org.uk/nicemedia/live/10968/29813/29813.pdf

Any child protection concern

Any consultation that you felt didn’t go well or if you felt the patient was unhappy with the outcome

Any consultation where you were made to feel uncomfortable by a patient for any reason

Chest pain – new or old

Any case where you consider admission may be needed

Any case you are considering referring to secondary care

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Any child under three months old

Any patient expressing thoughts of self-harm

IT - SystmOneThere will be time allocated during the induction timetable for you to familiarise yourself with our IT system. Kim and Graham constitute our in-house IT team and will gladly be able to help you if you have any problems, and should provide you with the logins you will need, as well as IT training.

Useful contact detailsLists of useful up-to-date contacts are kept in reception or via the following link;

http://www.drjcope.com/directory.html

ReferralsSecondary Care

NHS Smart cards will need to be issued for referrals made in your own name, please get in touch with our IT team to arrange this if you do not already have one.

Referrals for almost all secondary care are dictated using Lexacom, and are sent via TRAC (http://www.devonlmc.org/tamar_referral_and_appointments_centre__trac__and_sentinel_healthcare_cic_t63879.html?a=0) on choose and book. PLEASE MAKE SURE ALL PATIENTS YOU REFER HAVE A BP, HEIGHT, WEIGHT AND SMOKING STATUS IN THE LAST 12 MONTHS.

Orthopaedics, Colorectal Surgery and Gynaecology also need Hb, pulse and diabetes check. These must be within the last 3 months. We do not have to hold the referral for these results but they should be done before the patient is seen for their appointment.

There are a lot of things required for Fertility Clinic referrals and it would be useful if Doctors could check with secretaries first before they do these to ensure all required tests are done prior to referral to avoid rejection.

2 Week Wait

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These are done by completing the appropriate blank referral form, through SystmOne and then to hand this to one of the secretaries or a receptionist in person.

Mental Health

Dictate letters for CMHT; urgent same day referrals can be made by calling the crisis team directly.

Physiotherapy, SALT, Dietician

Through different forms on the clinical system.

CorrespondenceYou will have a ‘tray’ in reception and this needs checking every working day; here you will find prescriptions for signing or messages from patients/colleagues and all external personal mail.

We use a ‘scans’ electronic mail distribution system within the clinical for patient-related external mail.

Actions from correspondence can include (and usually does) updating medication lists from discharge summaries or arranging investigations or reviews at hospital’s request and so on.

We use TASK’s in the clinical system to pass on non-urgent messages within the practice team

There is also an instant messaging facility, which has been a very useful communication tool between trainers and trainees.

InvestigationsHospital Investigations

Most investigations are made either by form or letter via TRAC. Use the label trace printer to add patients details to request forms. We hope to have ICE electronic requesting / reporting system in place soon.

Ultrasound referrals can be made to Sonicare, who visit the practice fortnightly, however they do not accept vascular, neck or interventional requests.

Plain x-ray – normally go to Derriford but do get offered a choice, for CXR give patient form and can attend anytime during normal working hours, all other requests give form to reception for fax and hand patient top sheet and advise to ring no. to make appt. the following day.

The options are varied and extensive, it will likely be best to discuss this with the supervising GP.

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Practice Based Investigations

Blood tests

ECG’s

24 Hour BP monitoring

ABPI’s

Spirometry

…… are all available at the surgery, please give the patient a request to hand to reception so an appropriate appointment can be booked.

Results

All investigations results received via ‘pathlinks’ (computer based and linked to patient’s record) will be returned to the requesting doctor. We will arrange for you to be registered on the system so you can receive your own results. You must record your actions in the patient’s records. These results should be dealt with daily and if you are away on holiday or study leave arrangements will be made for another GP to check your results.

Prescribing

Repeat Prescriptions

It may be that you are asked to sign repeat prescriptions on completing morning surgery, ideally before attending home visits as pharmacy collections are early afternoon. These may include acute prescription requests or controlled drugs (see below).

Formulary

We are striving to achieve the highest standards in cost effective prescribing, please use Plymouth area joint formulary (http://www.plymouthformulary.nhs.uk). If you think that a patient may benefit from a non-formulary or high cost item then please discus with the supervising GP.

Antibiotics

It is our policy to limit antibiotic use for self-limiting illness such as sore throats, simple conjunctivitis, simple otitis media and URTI.

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The use of Quinolones and Cephalosporins should be on an extremely limited basis and should be discussed with a Partner if you are uncertain of the indications.

Please see Plymouth area joint formulary for more information.

Controlled Drugs

Drugs covered – diamorphine /morphine/buprenorphine/fentany/oxycodone/pethidineRarely used but included-dipipanone/paveretum/meptazinol/hydromorpho

METHADONE SHOULD NOT BE PRESCRIBED IN ANY CIRCUMSTANCES.

Initiation of scripts and dose adjustments: GP’s responsible for documenting doses in electronic records. GPs to be aware of safe levels of opiate dose increase (eg for oral morphine and oxycodone not normally more than 50 pc higher than previous dose) Opiate conversion charts are available in the consulting rooms and via;http://www.drjcope.com/uploads/1/3/1/4/13140168/palliative_care_drug_converter_1.pdf

CD scripts should be entered as an acute so that future scripts have to be printed out by a GP who can check that the request and details are appropriate. GPs should enter on the consultation screen where dose or strength has been adjusted from a previous dose so that the new instructions are noted as intentional.

Emergency Use of Controlled Drugs by GPST’s

We will discuss with you regarding the carrying of controlled drugs early in your post.CD drugs are kept in a safe in reception, if they are required, they need to be signed out in the presence of one of our receptionists, and signed back in again if returned unused.If used the CD register need to be amended accordingly.

Emergency Supplies

A small supply of medications is kept in the emergency bag cupboard and in the emergency bags themselves for use in emergencies.

Read CodingALL patient contacts should be recorded clearly in the electronic record.

When reviewing hospital letters via workflow please highlight all relevant items for coding and forward to Jean. Alternatively please code these items during consultations if appropriate.

The following list provides a guideline as to what is read coded onto the system.

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Chronic Diseases- GMS contract Indicator

Significant diagnoses- e.g.- Rheumatoid Arthritis, Cataract, Eczema (all as high priority)

Operations and Procedures, Fractures, Hospital Admissions

MRI Scans, X-rays, CT scans, Bone scans, ECG results etc.

Smear results

Breast screening

Allergies

Immunisations

Births, Miscarriages, Terminations

Death or bereavement

Family history of chronic disease or cancer

Jehovah’s Witness

Living will in notes

Treatment escalation plans

This list is not exhaustive.

If you are not sure how to enter read codes please ask.

Enhanced Services

Please be aware of the following important services. In general the codes can be found within the Encounter Screen template of evolution LES/DES template. Coding is vital as this is how we claim.

Minor Injuries

If seen in the first 48 hours, remember this includes things such as sunburn and insect bites. PLEASE CODE using the auto-consultation tab.

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Minor Surgery

If you would like to book something for a minor op then use ‘request form’ and ask patient to go to reception. In general, do not obviously malignant lesions, pigmented lesions or lesions on face or hands – these should either be via Sentinel and C&B, if in any doubt ask.

Contraception Services

We provide coil fitting and removal and Nexplanon implants as well as the usual contraceptive services. Please ask patient to book at reception. REMEMBER patients given the pill or MAP need advising re long acting contraception and coding for this. You should use the contraception template.

Pre and Post Hospital Care

The surgery is paid for undertaking this and must be coded as above, if requesting nurse input e.g. blood test requested by hospital please make this clear in consultation note.

Quality Outcomes Framework

During your attachment you will learn more about the QOF but included below are some early pointers which require action at the point of seeing patients.

Depression

When diagnosing depression it is essential that patients have a biosocial psychological assessment at beginning and during their treatment and we read code this.

Contraception

When doing ‘Pill Checks’ patients need advising re the option of LONG ACTING CONTRACEPTION (LARC) and coded, most easily via the contraception auto-consultation tab.

Hypertension

New diagnoses need LIFESTYLE ADVICE coding and a Cardiovascular Risk Score undertaking, available via Qrisk in clinical tools within the patient record in SystmOne.

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Chronic Disease Management Clinics

Our experienced practice nurse team oversees nurse led chronic disease management clinics in the following areas

Diabetes Asthma COPD Hypertension Coronary Heart Disease Heart Failure Learning Difficulties

Please feel free if you are seeing any of these patients to complete any QoF alerts that appear on their home screen, or to request they book back in with the nurses for follow up or if they appear to be due for review.

Medical EmergenciesResus equipment is available in the treatment and all equipment and drugs should be available on these including defibrillators.

Nebulisers are also available for use.

MOST IMPORTANTLY please shout for help, someone will always respond.

Child ProtectionBelow are the contact details you will need but if you have ANY concerns about a child at our practice please inform the Practice Manager or Partner so this can be followed up in line with our procedures.MASH (Multi-Agency Safeguarding Hub) – 0345 155 1071

Complaints The Practice operates a fully NHS compliant complaints procedure but obviously we would try to avoid complaints and if you feel a patient has a concern it would be helpful if you flagged this up to the Practice Manager so that appropriate action may be taken.

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If it is clear a patient would like to make a complaint please direct them to reception where they can collect our Complaints Procedure and Form. It is however our experience that this can be avoided in the vast majority of cases.

SecurityPanic buttons are triggered by pressing both recessed buttons simultaneously, be sure you are aware of where these are located in your room.

It is sensible not to lease valuables in your consulting room unattended, or to leave your room unlocked for any length of time.

We take information governance seriously, and no patient related/identifying material should go into the waste paper bin in your room, it should be disposed of in burn bags or by shredding.

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