Practice Induction

Induction: Sign & Date in the Comments box when completed

Welcome to our practice.

If you’re reading this you’ll be with us as a medical student or a Registrar in General Practice.

On this page we will try and orientate you to how things work at the two surgeries and what you can expect on a daily basis. You’ll be part of our primary care team and we get on with the work as a team; this means people will be there to help you in your training and you’ll be valued for your contribution to the care of our patients.

Before you start with us as a Registrar, you will need to be on the National Performers list. Without having the application processed you aren’t insured to see patients. This is sorted out through the Lead Employer.

Your Lead Employer continues to be St Helens & Knowsley Trust, and contract and employment issues should be directed to them. We will be responsible for the application of the contract and your training.

It’s all about patients- our career is about listening to and understanding their experience and doing what we can to make improvements, whether that’s with a treatment, ensuring seamless care from hospitals, communicating with the multi-disciplinary team or simply being there for them.

All of the protocols, the guidelines, the administrative workload and clinical governance aim to help us in that task, and if they are done badly they can certainly make that care of the patient more difficult. 

It’s still the best job in the world!

• Your first time in the practice

Hopefully you’ve found your way to the practice, with our helpful maps on the website for Horseley Heath or Tandon. It’s a rite of passage just to find your way to the car park on your first time! If you’ve struggled, you’re in good company.

Your annual leave entitlement as a GP Registrar will depend on your level of experience prior to starting training, but practically for most of our trainees this is usually 25 days per year, pro rata. In 2020 our Annual Leave system changed to BrightHR which you can download on your phone, (some features are different on the Desktop version of the site) We ask that you give us at least 2 weeks’ notice with all leave requests, and it is very rare that we allow more than 2 staff members on leave at the same time.

You will be sitting in with us at first so we can show you practically how our computer system (SystmOne) works.

Hopefully by the time of your arrival you will have your NHS smart card fully functioning and ready to go, and we have ‘dummy patient’ records on which you will be able to practice inputting information, new diagnoses, management plans, acute and repeat medications and how to view pathology results and communications from professionals outside the practice.

Try to get to know the people you’ll be working with in the team during your time here, including

clinical staff

admin staff

reception staff

We’re all quite approachable, and hope to make your time with us a rewarding one. Whenever you see patients one of our doctors will be available for face to face supervision should you need advice as expected as a trainee. 

• New for 2017: Junior Doctor Contract

Jeremy Hunt’s strike-inducing contract for Junior Doctors comes into effect in August 2017. This is very different to the way GPs work as your hours will involve continuous activity, from seeing patients to admin to home visits to rest to tutorials back to seeing patients.

We’ll try and make this reflect true General Practice as much as possible but the working week is limited to a total of 40 hours per week; 6 hours of this per month are removed as Time In Lieu of Out of Hours sessions, ie 1.5 hours a week.

Out of the 40 hours, 28 are Clinical and 12 are Educational. (before subtraction of OOH-TIL) Of the 28 Clinical Hours the ratio of patient-facing time to administrative should be 3:1.

Rest periods are 30 mins on days lasting between 5-9 hours, and a total of 60 mins if beyond 9 hours.

12 hours Educational time automatically include 4 hours VTS per week, with the remainder comprising tutorials and personal study.

Please see the document below that illustrates the hours set in your Generic Work Schedule sent to you over 8 weeks ago.

HHS-TMC JD Contract 2017 Visual format
A table version with coloured blocks illustrating the working week.

HHS-TMC JD Contract 2017 60% LTFT VIsual Format
A workschedule for a 60% Less Than Full Time Trainee

Please bear in mind the job after finishing training will not reflect that of the 2017 contract. GP contracts are to see patients between 0830-1830 Monday to Friday, and frequently involves discontinous activity, without a 3:1 ratio of patient to administrative activity.

For the purposes of passing the SCA exam it is recommended to be seeing between 90-100 patients each week. If seeing patients at 10 minute intervals under the proposed conditions a maximum of 90 patients can be seen in the 15 hours if every slot is filled.

Your personal study 4 hours can be chosen for whatever activity you feel would best serve your development.

• The incoming post

Sadly for the environment, a practice with over 11,000 patients (and growing) has to deal with alot of letters each day, this will be reduced by increasing numbers of electronic tranfer of correspondence via SystmOne. Our administrative staff will process these, but as Doctors it is our job to help the team out by filtering those letters that are for

a) information only, (to be scanned or filed as complete)

from those where

b) a change in treatment is implied, (to be changed by a clinician)

or containing

c) valuable information that provide evidence of our care for the patients, (to be coded)

The letters (paper and electronic) are divided equally amongst the Doctors working that morning. Many of the letters the practice receive are processed via Workflow to filter out the ones that don’t require a clinician’s attention.

Information-only letters can be filed into the patients notes without any extra work for our data entry clerks. 

Medication changes should be the duty of the prescriber, so any suggested changes to the patients medication regime should be actioned by the Doctor going through that letter. Onward referrals will also be the duty of the Doctor processing the letter.

Some of the letters will contain information that help us provide evidence of the care provided by patients: Blood Pressure readings, Cholesterol results, eGFRs, Depression severity questionnaires and more. We need to highlight these in the letters so they can be correctly coded by our data entry clerks to satisfy the rules of the QOF.

• Electronic Prescribing

It’s the 21st Century and electronic signing of prescriptions is up and running at the practice. While there may be named prescribers allocated this is not evenly distributed, so to make things fair we divide the ETP scripts between the number of Doctors at the site at the end of surgery- for instance if 2 on, one prescriber takes half the scripts, and the other takes their half, (as if they were paper-based prescriptions in our box at the end of surgery). By listing the ETP scripts in order of patient surname we can ensure one prescriber does the first half of the alphabet and the other dose the latter half, or whatever appropriate proportion of the workload.

• Ardens Templates

Ardens templates are used in many practices in the UK, and they have a fantastic suite of videos on how to use their templates to save you time- you have a fresh pair of eyes and so using theses templates within SystmOne offer Quality Improvement opportunities for you to devise ways we as a practice team could deliver services quicker or better!

Please follow the link for Ardens New GP & ANP Starters

• Blood Results

Following a review in 2016, the blood results will now be processed as follows; the aim being that No blood results will remain unactioned in the working week for longer than 48 hours.

Practically this means that we process results when we have them allocated to us.

When processing the blood results, you will see numerous action options, however the practice agrees a system where only 3 of these are actioned:

• Take No Action
• Make an Appointment to see Doctor
• Make an Appointment to see Nurse

While common sense, clicking the options for ‘telephone appointment’, ‘pick up prescription’, etc will not come to the administrative team’s attention for action, so please treat these boxes as if they do not exist!
When making the decision for either no action or recall, if the decision is to Recall, please click on the box at the bottom of the recall box that means the blood result is not ‘Archived’

If the result is Archived, the recall system cannot identify the patient to be sent a letter of recall. 

• 2019/20: National Cancer Diagnosis Audit

The Practice is engaging in the NCDA for 2019/20- this involves receiving patient details from Cancers diagnosed in 2018 and looking to learn from the records leading to the decision to refer for specialist intervention for diagnosing the cancer involved.

We are using the same questions for the NCDA to review the latest Cancer Diagnoses from the practice as they happen through 2019/20 to see if incorporation of Cancer Safety-Netting Software on SystmOne makes a difference to the number of cancers we are diagnosing and hopefully reducing delays in reaching diagnosis, meaning a greater chance of longer survival after diagnosis.

The Software gives the practice a system for recalling patients you may be concerned about the possibility of cancer but not yet at the point where it is clear they should be urgently referred- it will allow us to pick up those patients who slip throuhg the net or never come back for the intended follow-up that may have revealed significant symptoms of cancer.

Instructions on using the Safety-Netting Software will be part of your face to face induction.

• The Quality Outcomes Framework & Primary Care Commissioning Framework: QOF & PCCF

Hopefully you might have come across this term before, but if not, here’s your introduction.

QOF/PCCF are the ways General Practices provide evidence of the care we provide in some of the commonest medical conditions and how the business is set up. 

It’s not comprehensive and it will be tweaked each year to reflect the national priorities and it represents a significant financial aspect of running the practice. The more we earn through QOF & PCCF, the more services we can fund through the surgery.

There’s alot of running the business and caring for patients that isn’t part of the frameworks, but if we look after QOF & PCCF we should be providing alot of evidence-based care that improves the lives of our local population, for instance through primary prevention of cardiovascular disease, or following up patients with depression, controlling risk factors and ensuring effective chronic disease management.

You will gain practical experience in the various tasks of QOF & PCCF in addition to looking at aspects of managing the business side of general practice, and we encourage you to develop your own views on how such targets positively enhances general practice and in what ways it can be critiqued.

Please leave a comment in the Comments box below: this provides evidence of your induction at the practice.