The main administrative task at the beginning is to get an NHS Smartcard - if you already have one (I had one as a medical student) this can be reactivated. I didn't contact the surgery in advance as it was very straightforward to set up for me but if you do not have an NHS Smartcard, it may be worth contacting your practice shortly before starting to set up an account.

If you are working at Mill Road Surgery, there are two branches: Mill Road Branch (279-281 Mill Road, Cambridge CB1 3DG) Cherry Hinton Branch (204 High Street, Cherry Hinton, Cambridge, Cambs, CB1 9HJ).

The main surgery is Mill Road Branch but you will spend time at both Mill Road and Cherry Hinton. The first week is a combination of induction to SystmOne (the computer system) and shadowing GPs and the Practice Nurses.

GP is Mon-Fri with one half day. At Mill Road, the half day is usually on a Tuesday afternoon. At Mill Road/Cherry Hinton, you are given time to attend the weekly Addies teaching. The afternoon appointments are scheduled later to allow enough time to get there and back.

Annual leave and study leave are easy to book as you are supernumerary.

Week 1 - shadowing +/- attending home visits. You may also see patients during this time with your supervisor observing.

Week 2 onwards - start seeing patients independently. Starting with 40 mins for each patient, which is reduced to half an hour after the first week or so. Some practices start at 30 mins.

At my surgery: 9-11:30 is morning surgery followed by debrief about each patient with supervising GP 14:30 - 17:00 afternoon surgery followed by debrief about each patient with supervising GP Most paperwork can be done in the lunch break Thursday afternoons off for private study Tuesday lunchtimes: referrals meeting where all of your referrals need to be approved by the team

This varies between surgeries- nowhere is 9-5 though! A typical day is morning clinic 8.30-11.30. Then debrief with your covering GP, home visits, meetings and admin 12-2.30. Squeeze lunch in somewhere! Afternoon clinics 2.30-5 and then debrief with the afternoon covering GP once they've finished their clinic and be warned they will probably be running late.

At Mill Road/Cherry Hinton, Tuesday morning is dedicated to a weekly tutorial where you are expected to contribute with a short presentation or interesting case presentation. The tutorial timetable is often agreed between the GP Registrars. This is also a good time to get Supervised Learning Events signed off. The tutorial is then followed by the weekly referrals meeting where all referrals to secondary care are discussed and approved by the team.

At the Royston Health Centre you are attached to the duty doctor who sees the same day patients of GPs who are not working that day. Sometimes you will do home visits - this is not as daunting as it sounds, and the duty doctor is always just a phone call away - you will be given a list of their mobile numbers.

At the Royston Health Centre, you are also expected to check blood/imaging/test results daily, while helping the duty doctor. This includes looking at the results for the doctors who are on annual leave or are off that day (each partner has one day a week when they are not doing a clinical session at the practice). For doctors on annual leave, normal tests need to be filed (check notes to see if there is a further plan the GP has made for if those results come back normal and let the GP know so they can action their plan) and abnormal results need to be actioned e.g. antibiotics may need switching once sensitivities are back; transfusions may need arranging; patients may need to be asked to come in to see a doctor to have results explained to them etc. For doctors on their day off, all results need to be looked at and any urgent results that need actioning before the doctor comes back the next day need to be actioned and the non-urgent results can be left for the GP to action when they are back the next day. Calling the patient and speaking to them on the phone can be helpful in sorting out how to action the test results depending on what they show. Any grossly abnormal test results or ones you are not sure how to action should be discussed with the duty doctor who is also responsible for checking the results with your help.

Some GP practices will ask you to attend weekly nursing home ward rounds. This gives you a chance to see general practice in a different setting. You will be asked to review patients who are unwell and make prescription amendments. Once you are confident enough, you may be asked to do the ward round be yourself.

===== The typical patient : There is no typical patient, in gp the range of patients and conditions is huge. You see new borns to 95 year olds as I have, you see chest infections, urinary infections, back and knee pains, headaches of different sorts, broken wrists and lacerations, it is a very good range and mix of conditions. Very good learning experience.

After 4 months of GP, you will be in expert in writing a quick and concise referral letter! However, it is worth noting that if your GP practice uses Systmone then there are many referral letter templates already available. It is worth looking into which conditions or clinics have their own referral template as this will save you time in the future.

Once you start seeing patients independently you should always be able to discuss the patients that you've seen at the end of the day with one of the senior GPs. But remember, you will probably be the only person to see that patient. If you have any concerns, ask one of your GP colleagues to come in and give you a second opinion while you still have the patient, or alternatively ring the on-call registrar of the relevant specialty in the hospital. If you are still worried after having discussed with a GP colleague, ring the Specialty Registrar. They are usually hugely helpful, and it gives you the confidence that you have managed the patient properly.

It is an unbanded job, but the job should have oncall time with it so that it can be banded. The hours are not bad, but there is little you can do with the time left at the end of the day if you have a child, you certainly can't revise for mrcp. Rota is fairly flexible in terms of taking annual leave but the rest is fairly fixed as you are there to help the duty GP of the day, so leaving early is not really an option. But overall its a very good learning experience.

www.patient.co.uk www.gpnotebook.co.uk

http://cks.nice.org.uk/ - Useful summary of guidance on diagnosis and management and when to refer aimed at primary care

If you are based in Cambridge the Addenbrookes GP Connect pages (http://10.154.5.9/index.cfm?articleid=104) are invaluable. Many specialties have their referral criteria there, in addition to useful resources (information sheets for IBS etc.), local microbiology and antibiotic guidelines etc.

Referrals to psychiatry/psychology/IAPTs are done through the Advice and Referrals Centre (ARC), and the referral form is on the their website if your surgery haven't incorporated it into their electronic notes system.

- Find out from your surgery what the direct line is to your local hospital (some hospitals have separate lines for GPs so that you don't need to go to main switchboard, this can save you lots of time!).

- Add some common generic links to your favourites bar (eg back care, BNF, dermnet.nz etc) - saves a lot of time searching for the same information again and again.

Useful info for GP Rotation at Newnham Walk Surgery

Oral contraception: -Click on the blue circle -‘Sexual health/contraception’ -2nd tab - ‘pill check’ -Useful info: -FPA website -Leaflets -http://www.fsrh.org/pdfs/CEUGuidanceCombinedHormonalContraception.pdf

Mental health: -Click on the blue circle -Patient Health Questionnaire -Useful info: -University counselling service -IAPT Cambridge -IAPT self referral -Councillors list in shared drive - point out Samaritans -www.getselfhelp.co.uk -Mood juice website -If starting on SSRI, review within 1 week

Sexual health clinic: iCash, 0300 300 3030, www.icash.nhs.uk

Services available at the surgery (no need to refer, to book appt with nurse): -Spirometry -Audiometry -Family planning clinic - eg. insertion of IUD/IUS/implant. -Minor ops eg. biopsy, removals - to book appt with Dr Linehan in minor ops clinic on a Monday afternoon. Best to get Dr Linehan to look at the patient first if he is around

Cambridge CCG AntibioticFormulary: http://www.cambsphn.nhs.uk/Libraries/NHS_Cambridgeshire_Formulary/Antimicrobial_Guidance_Full_version_November_2015.sflb.ashx

BNF, BNFC and CKS (clinical knowledge summaries) websites

Physio direct, self referral: http://www.cambscommunityservices.nhs.uk/docs/default-source/physio-direct-forms/physiotherapy-self-referral-form---cambridge-oct-2015.pdf?sfvrsn=10

Link for TQuest settings reset: https://tquest.addenbrookes.nhs.uk/tquest/index.php