Primary Care

Home visits are a fundamental part of General Practice. They provide excellent learning opportunities for students to see how medical problems can affect the functionality and quality of life of a patient.

Incidents of violence or aggression are rare in the community. However, visiting patients in their own homes as a lone student exposes them to the potential risk of injury due to a violent patient or relative/pet, or of injury whilst travelling in the community. Therefore, we request that students do not attend home visits on their own and are supervised by a GP tutor, or a nominated clinician, when attending a home visit.

Please consider whether the visit is suitable for a medical student. A number of factors increase the risk of home visits, including type of accommodation, locality, history of alcohol misuse, drug misuse or violence. Before every visit, the GP tutor/supervisor should ascertain the level of risk the medical student would be exposed to during the visit when deciding if the visit is appropriate for the student. The risk could be physical or psychological. High risk visits are not suitable for medical students. We would include visits to patients with confirmed COVID-19 as high risk and unsuitable for students.

Welcome to the surgery

• Tour of the facilities at the practice
• Advise student of the named clinical and administrative lead and the contact details of the person they should contact in the case of illness or lateness
• Introduction to staff members. Consider providing a written list of staff and their role within the practice.
• Familiarisation with the physical setting - Availability of local shops for food/drinks
• Reminder of professional responsibilities including dress code, conduct, punctuality, name badge.
• Ensure that students are informed of any car parking restrictions.

Safety whilst on GP placement

• Named GP and administrative lead contact details with whom the student should raise concerns whilst on placement – these may include patient safety, student safety, student wellbeing, staff safety, harassment, undermining or bullying.
• The University raising concerns ALERT form link is now on the students e-portfolio to enable students and staff raise concerns directly with university.
• Advice to be given to students to include safety advice regarding the local area, Home visit safety (students not to attend home visits with GP supervision), panic alarm system.
• Ensure students have read “staying safe” section in GP student handbook.
• Location of safe place to leave coats, bags, bicycles etc, signposting to policies as below
• Health and Safety guidance and policies to include:
• Panic alarm system
• Infection Control
• Raising concerns/whistleblowing/harassment/undermining/bullying policy
• Confidentiality
• Fire safety
• Safeguarding
• Chaperone policy
• Complaints policy
• Information ann data handling
• Needle-stick/accident policy

Please note - If a needle stick injury occurs, please manage as per local protocol and inform us via email: mbchb@liverpool.ac.uk.

Timetabling and meeting with GP tutor

• A timetable for the placement including expected times to arrive/ leave and what they are doing for each session. This can be done on a weekly or entire placement basis, and can be printed or emailed to students.
• Induction to computer systems and record keeping IT, data management and information governance, including access to and basic training on the practice patient record system.
• Reminder about student obligations for confidentiality and consent for patients (Duties of a Doctor) including anonymising case histories.
• Initial meeting within the first week (ideally on the first or second day) with the GP tutor to discuss learning outcomes and aims for the placement. This should include timetabling, tutorials, arrangement for feedback to and from students, e-portfolio requirements, student wellbeing and raising concerns.

• Students attend the practice for 7 sessions a week for 4 weeks in Years 3, 4, and 5.
• They are released from the practice on the same day each week to attend CCT teaching.
• The remaining half day away from practice is for the student’s personal learning and can be scheduled by the practice.
• Students may ask for this to be Wednesday afternoon in-line with other university activities, but this is up to the practice to decide.
• During their time in the practice student doctors should be involved in as much normal practice activity as possible. These should include Observing GPs, Nurses and other clinical staff, Consulting Independently, Home Visits, and specified Mandatory Experiences. It can also include Meetings, reviewing Laboratory Results, making referrals, Phlebotomy, Vaccinations, sitting with Reception. This list is not exhaustive, and we encourage practices to involve student doctors whenever possible.
• We recognise that every practice is unique and works differently to other practices, thus we accept that there must be a degree of flexibility in the structure of the student doctor’s time over their placement. 

Leading on Consultation

• 3-4 sessions each week should be spent with students leading on consultations with patients. This can be done in pairs with one Student Doctor leading the consultation, with indirect supervision of a GP (see FAQs), subsequently presenting the cases to the GP.
• Consultations can be face-to-face, telephone, or video consultations, although we prefer that the majority are face-to-face. Each pair of Student Doctors should aim to lead on consultations with approximately 9-12 patients per week, on average, over the placement. Students will need approximately 20 minutes to take a focused history and examination before presenting the case to you. The GP Tutor will then need to discuss diagnosis and management with the patient. All patients seen by Student Doctors will require formal clinician review.

Surgery Observations

• 2-3 sessions sitting in and observing a GP surgery with the opportunity to become involved in clinical examinations and engage in case discussion. This could occur in pairs or individually with different practitioners. If telephone consulting with a patient please ensure telephone consultations are audible to Student Doctors and ensure consent is given by the patient for Student Doctors to observe, just as you would for a face-to-face consultation.

Experience of the Primary Healthcare Team

• 1-2 sessions per week with another health care professional – including Practice Nurses, GP trainees, Health Care Assistants, District Nurses, Community Midwife, Health Visitor, Community Physiotherapist or others as appropriate. This could occur in pairs or individually with different professionals.

Educational Supervision

• The GP tutor will act as the student’s Educational Supervisor for their GP placement. 
• Please visit the Educational Supervisors section for more details.

Mandatory Experiences

These are essential activities that the Student Doctors MUST experience during the placement. They can occur in pairs or individually. They should be achievable within the 4 weeks of the placement as they are commonplace aspects of a practice’s daily and weekly activity:

• Each should be followed by an in formal debrief or discussion with a GP. Their reflection will be documented in their e-portfolio. Please visit the Educational Supervisors section for more information.
• For further details on these mandatory experiences please see the Year 3 GP Handbook 2023-24 (.doc), Year 4 GP Handbook 2023-24 (.doc). Please be aware the experiences are different for each year group. 

• Year 5 student doctors should be involved in multiple aspects of acute care of patients, triaging under direct supervision, consulting with patients independently (with indirect supervision), assisting clinicians during their consultations, and managing patients through the primary-secondary care journey.
• Student doctors should have more self-directed time, with indirect supervision, to complete their Mandatory Experiences.  

Leading on Consultation

• Some sessions each week should be spent leading on consultations with patients, in pairs with one Student Doctor leading the consultation, with indirect supervision of a GP (see FAQs), subsequently presenting the cases to the GP.
• Consultations can be face- to-face, telephone, or video consultations but we prefer the majority to be face-to-face. Each pair of Student Doctors should aim to lead on consultations with approximately 9-12 patients per week, on average, over the placement. Students will need approximately 15 minutes to take a focused history and examination before presenting the case to you. The GP Tutor will then need to discuss diagnosis and management with the patient. All patients seen by Student Doctors will require formal clinician review.

Shadow and assist the on-call GP

• This could occur in pairs or individually with different practitioners. To build on student doctors’ previous experience observing consultations in years 3 & 4, Year 5 student doctors should be tasked with assisting the GP, for example inputting consultation details into GP records, including requesting investigations. These activities require direct supervision.
• If telephone consulting with a patient please ensure telephone consultations are audible to Student Doctors and ensure consent is given by the patient for Student Doctors to be involved, just as you would for a face-to-face consultation.

Educational Supervision

• The GP tutor will act as the student’s Educational Supervisor for their GP placement.
• Please visit the Educational Supervisors section for more details.

Year 5 Mandatory Student Experiences

• These are essential activities that the student doctors MUST experience during the placement. They should be achievable within the 4 weeks of the placement as they are commonplace aspects of a practice’s daily and weekly activity.
• Each should be followed by an informal debrief or discussion with a GP. Reflection will be documented in their e-portfolio. Please visit the Educational Supervisors section (link) for more details.
• For further details on these mandatory experiences please see the Year 5 GP Handbook 2023-24 (.doc).

Please let us know if a Student Doctor misses a session, even if it has been pre-arranged or for illness.

Send absence reports for Year 3 Student Doctors to Rachael Carr: yr3gp.mbchb@liverpool.ac.uk

Send absence reports for Year 4 Student Doctors to Chris Johnson: yr4gp.mbchb @liverpool.ac.uk

Send absence reports for Year 5/SAMP Student Doctors to Vanesa Ahmetaj: yr5gp.mbchb @liverpool.ac.uk

If you have a professionalism or wellbeing concern for a student doctor, please visit the Sharing Concerns section for more information on how to inform the School of Medicine. For concerns regarding academic performance, please use your e-portfolio to log your concerns.