General practice is a very different experience to hospital medicine. You will meet many new people and encounter all sorts of conditions. You may be exposed to a lot of uncertainty: strange skin rashes, lumps and bumps, aches and sprains, odd-sounding symptoms, to name a few. Do not be afraid to ask. The general practitioner (GP) partners know you are in training and are happy to review patients if you are unsure. Use the opportunity to learn – general practice is one of the few times where you have the privilege of being the sole trainee to several tutors, most of whom are keen to teach. Working in general practice can take some time to adjust to. There is a lot more reliance on clinical skills and picking up signs. Blood tests and imaging aren’t always immediately available to you, which can be daunting at first. However, as you adapt to these challenges most people find that the job can be very rewarding.

What you can and cannot do

Referral letters and note keeping

The most important thing is to write referral letters as soon as possible after seeing patients. Practice notes are much briefer than hospital notes, so they may not provide sufficient detail for referral letters weeks later. Some GP computer systems allow you to generate a referral letter from your consultation documentation. This is a really easy way to write a referral letter, as all the relevant information is available when the patient’s history is still fresh in your mind.

General points

• Stick to a simple format:
  
  
  
  • The first line should tell the specialty team exactly what is wrong, for example, ‘Thank you for seeing this 17-year-old girl with recurrent bouts of tonsillitis’.
    
  • The next line/s should provide a brief summary of the history and a summary of any relevant examination findings.
    
  • The last paragraph should clearly state what you would like the consultant to do, for example, ‘I would be grateful if you could therefore consider this woman for tonsillectomy’. Note the wording; you can ask but never tell another professional what to do. In other cases you may simply be seeking their specialist opinion ‘I would be grateful if you could give me your opinion about…’.
    
  • Always send a list of their medications with the letter.

Public health and health promotion

The most common public health and health promotion matters you are likely to encounter are as follows: