Frequently Asked Questions

Student-led clinics: First and foremost we are very happy for you to be flexible in how you arrange the student surgeries. The model below is one suggestion which minimises the impact on available appointments:

This allows for 15 face to face consultations including 4 student consultations. Further consultations including telephone consultations could be added after this. Please note that we ask for students to consult independently with a minimum 12 patients across 3-4 sessions each week.

The students do not need to be directly supervised when seeing patients. Students who see the patient on their own before presenting the case, usually in front of the patient, give positive feedback on this method as it gives them much more of a feel of ‘being the doctor’. For the 3^rd years, especially early on in the year, having their own clinic is a challenge, but they know every patient will be seen by the GP after them and we want to motivate and engage them.

Student sitting in with GP: It is important that students have time to discuss cases and management plans and to examine patients in a supervised setting to get feedback on their clinical skills. We would recommend that in a 2 ½ hour GP surgery that at least three 10 minute slots are blocked to give time for this. Some practices will extend the surgery to account for this and thus maintain total appointment numbers.

The students are all DBS checked, are given advice regarding staying safe and know the professional standards that are required. They are able to see patients and examine them, although should be made aware of the practice chaperone policy and not conduct intimate examinations unsupervised. Students should not conduct acute home visits unsupervised. However, it is appropriate for them to see pre-arranged patients with chronic diseases, either at the surgery or at home alone, if the GP tutor feels this is appropriate. Consulting with patients in this way enables the students to learn about specific chronic diseases and address the learning outcomes of the placement.

Over the 3^rd and 4^th years of the MBChB course we want students to develop from information gatherers to a more active consulting style interpreting the information from their histories and examination findings to consider differential diagnoses, appropriate investigations and management plans. This will be a process over the 2 years and different students will progress at different rates. Certainly, students attending a GP practice early in 3^rd year may need more guidance to begin this process, whereas we would hope students attending towards the end of 4^th year should be able to present their GP tutor with a concise case summary, a likely diagnosis and a safe and appropriate management plan.

Each practice works differently and thus how patients are booked into the student’s appointments may vary, but patients must be aware that they are seeing a student at the time of booking and again when they arrive for their appointment. This may mean that student appointments are best managed directly by reception rather than online etc. It is useful to stress to patients that it will be a longer appointment, that they will see a student first and then the GP will see them. It is still possible to have a mixture of pre-booked and urgent/on-the day patients for the students.

Particularly in the early 3^rd year placements, the students will struggle with some of the complex cases that present in General Practice but equally some GP Tutors have reported that with patients who have very minor problems the students sometimes don’t know what to do (eg if it is ‘just an ear infection’ have they done an appropriate/comprehensive ENT exam or followed NICE guidance regarding assessment of a pyrexial child? If it ‘just a repeat of the pill’, have they done BP and discussed taking/missed pills/CIs etc?). It is important that students see a mix of patients including acute presentations and follow up cases.

This is a decision for each individual practice. They should be discouraged from writing copious notes during their consultations to ensure their attention is on the patient and they keep their history focussed. It can be helpful for students to take a couple of minutes at the end of the consultation before their GP Tutor joins them to structure their thoughts, decide on the key facts they wish to present and consider their differential diagnosis and management plan – making brief appropriate notes on paper or on the computer system can help some students with this process. If students do make an entry on the computer then we would recommend that it is only in the form of freehand notes and not coded data. The supervising GP should always make their own entry in the notes after seeing the patient.

Students should be encouraged to be proactive during the middle of the day, reflecting on the cases they have seen, identifying their learning needs and addressing them via the various on-line resources available for them on via the University interactive portal. It would be appropriate for the students to accompany GPs on home visits on at least some of the days they are at the practice or alternatively there may be appropriate patients with chronic diseases that the GP Tutor could arrange for them to visit. Please consider our Home Visit Policy here. Students should also be encouraged to prepare for afternoon consultations by reviewing patient notes in advance and this may help them to make the most of patient contacts.

Students should have access to the computer record for each patient they are seeing to help them prepare for the consultation. Whether they have their own individual log-in details (probably better for IG purposes) or a generic/locum log-in (probably easier to administer) is up to each individual practice.

The students are still in training: they should not be regarded as competent in any procedure and must be supervised by a responsible clinician. They will have evidence in their e-portfolio of the procedures they have been taught in their clinical skills sessions. Students must also be directly supervised for all intimate examinations.

General practice provides a wealth of learning opportunities not always available in secondary care. Should there be a learning opportunity for a procedure which is not itemised in the clinical skills list the student will be able to fill in additional DOPS forms to upload in their portfolio. We encourage students to use the GP placement to practice clinical examination and clinical procedures.

When sending us your invoice, please ensure the following so that your payment is not delayed:

• The signed Service Contract has been returned to us (we cannot make payment without this)
• The invoice has been transferred onto practice letter headed paper
• The invoice is addressed to The University of Liverpool
• You have included a date and invoice number
• You have copied the appropriate invoice that relates to the student year in question (we are happy to accept your invoices immediately after the relevant block starts.)
• Please submit a separate invoice for each student stating the name of the student and selecting the block/period they attended.

Changes to how GP surgeries work should be incorporated into student doctors’ experience on their placement. It can be very useful for student doctors to take an initial triage-style history from a patient before presenting it to a GP and discussing the management plan. The supervising GP should always make their own subsequent assessment of the patient, either by telephone, by bringing the patient into the practice, or home visit as appropriate. It is good learning for student doctors to be further involved in the assessment and management of patients that they “triage”.

Since 2017 all student doctors are provided with a medical scrub style uniform to wear while on placements. This is now mandatory for both primary and secondary care placements. We advise that they travel to and from placements in their own reasonably smart clothing, changing into/out of scrubs at the practice.