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PUNs and DENs: Discovering Learning Needs in General Practice (Radcliffe Professional Development)

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As a clinician at the frontline of health services, you will need to understand not only how to work within systems of healthcare but also how to work with those systems for the benefit of your patients. This will require an understanding of the context, structures and processes in and by which care is delivered. This goes beyond that of your specific clinical role. If you consider that a requested prescription would not be of overall benefit, you should explore the reasons for the request with the patient or carer. If you still consider the prescription would not be of overall benefit, or is likely to be harmful, you should not prescribe it and should explain the reasons for your decision. You should also explain what other options are available (including the option for the patient to seek another opinion) This area is about recognising and managing common and important medical conditions in primary care, demonstrating a structured and flexible approach to decision-making, and dealing with multiple problems and co-morbidity while promoting a positive approach to health.

Believe it or not, this approach is NOT named after me (no matter how much I wish it was). In fact, it has been developed by the Chartered Institute for Personnel and Development (CIPD). Although it was originally devised as an approach to focus analysis on key business outcomes, there is no reason why it cannot be used in the GP training world. It suggests that when we try and tease out learning needs, we remember 3 things… Sex; note some people may not identify with either gender group and this is referred to as non-binary gender or non-gender the importance of context and organisational culture and how this impacts quality improvement work; The problem is then solved with the new information (the gathering of more or new knowledge does not necessarily mean new learning) Qualitative measurements of health and approaches to qualitative research such as focus groups, Delphi analysis, ethnographyThe GMC expects all doctors to take part in systems of quality improvement. Quality improvement projects should be led by trainees, supported by their educational supervisor and include working as a team with other members of the practice to create a sustainable change. Health and Safety at work regulations relevant to general practice including infection control, vaccine storage, decontamination/spillage (COSSH regulations), safe practice and methods in the working environment relating to biological, chemical, physical or psychological hazards, which conform to health and safety legislation The elegance of this model is in its easy adaptation to the problem solving process often used by health care professionals.

This topic overlaps with others and, in particular, should be considered in conjunction with the following RCGP Topic Guides: It is essential that GP trainees gain a good understanding of quality improvement, prescribing and patient safety before completing training. Primary care settings, both inside and outside the practice, are ideal environments to learn and apply the key principles. As a GP, you are expected to understand the principles, strengths and limitations of evidence-based practice. The process of evidence-based practice was defined in the Sicily statement, 2003 1. It involves five steps: Active health promotion within the consultation, including the shift from theory to clinical skills in behaviour change; the potential tension between this role and a patient's own agenda At different positions in the health organisation (for example, junior doctor, salaried or partners)

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Role-played consultations, for example during teaching or courses, are valuable in exploring consultation behaviour in a safe environment, especially those using 'standardised patients' (played by actors or role-players who have been trained to react in a consistent or specific manner). Gathers information from history taking, examination and investigation in a systematic and efficient manner Conducts examinations with sensitivity for the patient's feelings, seeking consent where appropriate.

Recognition of 'red flag' elements in the patient narrative which may require urgent intervention to minimise risk As a specialty trainee, primary care is the ideal place for you to learn about the GP consultation in practice. There will also be excellent opportunities in secondary care settings. Examples of how to make the most of your clinical experience include: Information technology to facilitate clinical and business practice (for example, chronic disease surveillance, audit, financial management)The consultation between doctor and patient is at the heart of general practice. It is the central setting through which primary care is delivered and from which many of the curriculum outcomes are derived. The skills used in the consultation are transferable to other areas of professional practice. For example, your communication skills and approaches with patients are transferable to how you work with colleagues, in leadership and in teaching. Having highly developed communication skills is pivotal to all aspects of high quality patient care. For some, it has put a significant financial strain upon ourselves and our families with the loss of normal work opportunities, particularly for locums. For others, the worry for their own health and that of their families has been huge. At times patients’ needs may not be fully met because, for example. you are unable to tell them the times when the Special Clinic is open, don’t know who is the best surgeon for referral with impotence, don t know whether they can have free prescriptions. This Non-clinical knowledge PUN is best met by asking, delegation or ensuring that information resources are easily available within the practice.

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