What did I learn?
General practice gave me the opportunity to work with a whole mix of patients from diverse backgrounds. Every single day offered a completely different experience. Just during one morning surgery I saw a young mother anxious about seborrhoeaic dermatitis in her newborn child, an elderly woman with uncontrolled hypertension, a young chef with shingles, a pregnant woman with thrush, a 55 year old lady with post menopausal bleeding, and a chronic obstructive pulmonary disease patient who wanted to stop smoking, just to name a few.
The main part of the consultations was usually taken up by patient education, whether it was educating patients about avoiding use of antibiotics in common cold, explaining side effects of medications being started, advising about low fat diet or smoking cessation advice.
My GP tutor set aside one hour each week to discuss the most common conditions encountered in general practice. He also familiarised me with various issues related to General practice including consultation models, practice based commissioning, clinical governance, new GMS contract and quality outcome framework (QOF).
He also arranged different sessions with practice nurses, district nurse, receptionists, pharmacist, and optician. This gave me a wider perspective of general practice and made me understand the team effort that goes into providing good clinical care to patients. The practice manager also made sure that I was aware of the practice computer system. She walked me through the whole process of running patient searches for my audit and also showed me how to look at the population manager that keeps the record of how the practice is performing against the QOF standards.
So what is QOF and how does it affect patient care?
Quality and outcome framework (QOF) is a voluntary component of new GP contract for general practices. The QOF measures practice achievement against a range of evidence based clinical indicators e.g. number of patients with history of myocardial infarction currently taking ACE inhibitors. It also measures other indicators covering practice organisation and management. This has led to better provision of care to patients, especially those with chronic diseases.
One elderly patient with coronary heart disease attended the surgery with fungal infection of her toenail. My GP tutor looked at the alerts based on QOF indicators on her computer notes and realised that she hasnt recently had her BP checked and cholesterol measured. She also needed her flu jab. He seized this opportunity to measure her blood pressure, give her a flu jab, and also send her for blood tests. The patient aptly responded, I came here with only one problem doctor, but thank you for taking such good care of me.
Conclusion
I learnt a great deal about the NHS structure at primary care level, which is the first point of contact of patients with their doctors in UK. I had a chance to work on an audit and this exercise enabled me to understand the principles of auditing and clinical governance. (This experience will be vital to my future application to GP training schemes in UK??)
Everyone at the surgery was very friendly and always happy to answer any of my queries. I was generally under the impression that most of the patients will be against my sitting in during the consultations, but hardly any patient objected to this. They even wished me good luck for my future training as they left the consultation.
I would encourage overseas doctors to obtain some experience of NHS at primary care level to understand the bigger picture of provision of health care in this country. More GP practices should take on IMGs for clinical attachments specially those willing to pursue a career in General Practice.