Review of Observe GP portal

As part of my journey as an aspiring medic, I have been able to secure work experience opportunities at different hospitals and a care home. However, it has not been possible to find an opportunity to shadow GPs at local surgeries so I was very pleased to find the Observe GP portal (https://www.rcgp.org.uk/your-career/work-experience/observe-gp) listed as a valuable online alternative by the Medical School Council website (see https://www.medschools.ac.uk/studying-medicine/how-to-apply-to-medical-school-in-the-uk/work-experience).

Observe GP is conceived as an alternative, or relevant, work experience for aspiring medics who do not have direct experience of shadowing the staff at a GP surgery. The portal would have been especially useful during the Covid 19 lockdown periods, which would have essentially made any type of work placement difficult to arrange.

The portal provides a number of short interactive videos in which different employees of a GP surgery discuss their roles and responsibilities. The emphasis is on how each members of the practice collaborate to provide health care to patients.

Four sample patient consultations are shown in order to highlight the different techniques for diagnosing and interacting with the patients. This is indeed a privilege since in real life patients have the option not to allow work placement observers into the consultation room; being able to ‘witness’ these interactions on video worked very well and provided me with numerous insights.

Patient confidentiality is indeed a recurring theme not just for GPs and practice nurses but also for other members of staff (e.g. practice managers and receptionists). Patients are often willing to share private details and worries with their GP, which they wouldn’t want to share with others.

Patient records need to be secure and only shared for legitimate health care reasons. This brings up another theme: the foundation on which a general practice sits is TRUST and this is evidenced by the practice professionals’ everyday interaction with patients.

While working through the videos and activities, a number of facts are provided:

90% of patient contact in the NHS is undertaken in general practice

One million GP appointments take place each working day in the UK

One third of all GP appointments involve mental health

15.4 million appointments were missed in England (2018 figures)

Diagnosis is composed mainly on analysis of the patient’s story (80%), physical examination (5-10%) and, when required, further tests and investigations (10%).

The portal begins with an introduction from a practice manager and a discussion of how waiting rooms’ layout and installations are designed to make the experience more comfortable for patients and to inform them of news, social events and health-related opportunities.

A general practice needs to be inclusive and welcoming to registered patients, who may represent different genders, ages, ethnicity and socio-economic circumstances.

The reception team highlighted the greater use of technology to manage appointments, check-in by patients and for the latter to request services. Receptionists are also trained to handle requests, sometimes having to defuse situations involving patients in distress. Triage of patients can be risky and reception staff are trained to spot red flags such as chest pain.

Observe GP pauses the videos and often asks the viewer to reflect on the last segment. For example, in the past I thought that receptionists’ tasks would be fairly straightforward and repetitive but now I think that a lot of care goes into their training. I would define the key sill of a receptionist to be able to detect urgent situations by being aware of the tone and choice of words used by the patients.

Consultation Videos

The consultation videos were well presented, in my opinion. Depending on their circumstances, patients may feel a range of emotions: confused, embarrassed, guilty for not coming to see their GP sooner, etc. and GPs are trained to use the correct communication techniques.

Effective communication, a core attribute of medical students and professionals, is indeed required at all times to handle the different personalities and range of emotions exhibited during consultations.

This involves appropriate the use of careful language, silence and pauses when discussing patient conditions but also the concept of asking patients for their ideas, concerns and expectations (ICE) when describing their situation. The patient needs to be involved in the process.

A number of processes are utilised by general practices to improve outcomes, for example:

• self-care or management – e.g. patients asked to take their own blood pressure at home instead of only being measured when attending the practice
• social prescribing – referring the patient to non-medical services as part of their treatment, e.g. community-based fitness groups
• holistic care – taking into account different aspects of a patient’s life, e.g. physical, psychological and social factors, when formulating a course of treatment

With regards to holistic care, a GP needs to consider what may be affecting a patient’s life, based on the confidential conversations in the consultation room. This may involve looking at the patient’s social/support network, stress levels, lack of sleep, grief, loneliness, frustrations, etc.

I will refer the reader to the Observe GP portal for the actual videos but a great number of concepts are introduced that merit further discussion.

As well as the concepts already mentioned in this article, I have become more aware of the need for safety netting whereby a GP would inform the patient of what to do if symptoms get worse following the consultation. This handles the possibility of the diagnosis not being quite correct since the GP does not have the same investigative tools at their disposal as a fully-equipped hospital.

Continuity of care, whereby a patient sees the same GP, is also important. As is the collaboration between GPs and the nursing team, who are taking more and more responsibility for the management of patients with long-term conditions.

Conclusions

I really recommend registering for Observe GP to both aspiring medics who have not managed to secure shadowing work experience at a GP surgery AND to those who have spent time at a general practice but were not able to observe all aspects of the health care professionals’ work.

The presentation via videos and intermittent tasks and quizzes keeps the viewer motivated and interested.

The portal introduces many aspects of the realities of providing primary care to UK patients and gives many opportunities for reflection. I am more aware of the training and preparation that GPs and other members of the general practice require in order to meet the needs of patients.

Aside from medical knowledge, general practice need to be excellent communicators and great team players.