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  • Question 1 - You receive a 'friend request' on Facebook from a patient of a similar...

    Correct

    • You receive a 'friend request' on Facebook from a patient of a similar age to yourself who you had a consult with earlier that day. What would be the most appropriate course of action to take?

      Your Answer: Decline friendship request and write a polite letter to the patient explaining it would be inappropriate

      Explanation:

      The General Medical Council has issued specific guidelines regarding the use of social media by doctors. According to these guidelines, if a patient contacts a doctor through their private profile regarding their care or other professional matters, the doctor should make it clear that they cannot mix social and professional relationships. The text implies that there is a risk of blurring boundaries if a doctor finds a patient attractive and receives a friend request from them. Therefore, it would be appropriate to decline the request. However, this doesn’t warrant removing the patient from the practice list. As long as professional boundaries are maintained, the patient can continue to receive care from the doctor.

      Duties of a Doctor According to the General Medical Council

      The General Medical Council has outlined the duties of a doctor in providing care to patients. The first and foremost duty is to prioritize the care of the patient. This includes protecting and promoting the health of patients and the public, providing a good standard of practice and care, and keeping professional knowledge and skills up to date. Doctors must also recognize and work within the limits of their competence and work with colleagues in the best interest of patients.

      In addition to providing medical care, doctors must treat patients with respect and dignity. This includes treating patients politely and considerately and respecting their right to confidentiality. Doctors must also work in partnership with patients, listening to their concerns and preferences, providing information in a way they can understand, and respecting their right to make decisions about their treatment and care.

      Finally, doctors must act with honesty, integrity, and without discrimination. They must act without delay if they believe that they or a colleague may be putting patients at risk and never abuse the trust of patients or the public’s trust in the profession.

      Overall, the duties of a doctor are to provide the best possible care to patients while respecting their rights and acting with honesty and integrity.

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      • Consulting In General Practice
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  • Question 2 - A 29-year-old man contacts the clinic to discuss his 'sick note'. He recently...

    Incorrect

    • A 29-year-old man contacts the clinic to discuss his 'sick note'. He recently experienced acute mechanical lower back pain after twisting his back while working in the garden two weeks ago. He self-certified for the first seven days with an SC2 note and then saw a colleague of yours a week ago who gave him a medical certificate to cover the last one week.

      Upon reviewing the notes, you notice that your colleague marked the fit note as you may be fit to return to work taking into account the following advice and has ticked amended duties and has handwritten in the comments section: to avoid heavy lifting. The fit note has been marked, I will not need to assess your fitness to work again at the end of this period.

      He works in a factory and some of his duties involve heavy lifting, but he is still able to contribute effectively in his role in other areas that do not involve heavy lifting. He informs you that his back has fully recovered, but his employer has requested a fit note stating that he is fit to resume his full work activities.

      What is the most appropriate course of action in this scenario?

      Your Answer:

      Correct Answer: You do not need to sign a 'return to work' note - he may return to full duties without any further input or paperwork from yourself

      Explanation:

      Return to Work Note: What You Need to Know

      When you’re on sick leave, your employer may ask you to sign a return to work note. However, you should know that you are not obligated to sign it. Employers may ask for this note to protect themselves or for insurance purposes, but you have the right to return to work at any time, even before the end of your sick note.

      It’s important to inform your employer that you can return to work without seeing your doctor again, even if the doctor has indicated that they need to assess you again. The Department for Work and Pensions (DWP) has provided guidance for employers and managers, which states that as long as a suitable risk assessment has taken place, returning to work early will not breach your Employers Liability Compulsory Insurance.

      In summary, if you’re asked to sign a return to work note, remember that you have the right to return to work at any time and that you don’t need to sign the note. Refer your employer to the DWP guidance for employers and managers to ensure that they understand their obligations and your rights.

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      • Consulting In General Practice
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  • Question 3 - A 35-year-old man comes to see you about his depression. He lost his...

    Incorrect

    • A 35-year-old man comes to see you about his depression. He lost his job six months ago and has been living on savings. He lives with his two sons who are both in school. He divorced six years ago and neither he nor his children have seen his ex-wife since. He says that he has been ignoring bills and is now running out of money, relying on food banks to feed his family. His landlord has issued an ultimatum after failing to pay rent.

      He says that his sister is in receipt of Universal Credit (UC), but he doesn't know anything about it. You have advised him to contact the Benefits Agency, but in the meantime, what can you say about Universal Credit in this man's case?

      Your Answer:

      Correct Answer: He will receive extra allowance if he has a health condition which prevents him from working

      Explanation:

      Understanding Universal Credit

      Universal Credit (UC) is a monthly payment that replaces six income-related benefits, including Income-based Jobseeker’s Allowance, Income-related Employment and Support Allowance, Income Support, Child Tax Credit, Working Tax Credit, and Housing Benefit. It is available to people in and out of work. If someone is currently receiving any of these six benefits, they do not need to take any action unless there is a change in their circumstances or the Department for Work and Pensions (DWP) contacts them about moving to Universal Credit.

      A person’s monthly Universal Credit payment consists of a standard allowance and any additional amounts that apply to them, such as having children, a disability or health condition that prevents them from working, or needing help paying their rent. If a patient claims UC on health grounds, they may ask for a fit note. In cases where a patient is working but has restricted ability to work, they may request medical evidence of their health condition.

      The patient will be referred to CHDA for a Work Capability Assessment, similar to ESA. Medical evidence, such as fit notes, is required until the DWP makes a decision on their claim. No further fit notes are necessary unless the patient wishes to appeal the decision. If the patient’s appeal is unsuccessful and it is determined that they are fit for work, further fit notes should only be issued if their condition significantly worsens or they develop a new condition.

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      • Consulting In General Practice
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  • Question 4 - An 80-year-old gentleman comes in seeking benefits due to his poor vision. He...

    Incorrect

    • An 80-year-old gentleman comes in seeking benefits due to his poor vision. He has been experiencing this for quite some time and had to give up driving a few months ago as he felt it was no longer safe.

      Regarding the registration of sight impairment, who is authorized to issue a certificate of vision impairment?

      Your Answer:

      Correct Answer: Consultant ophthalmologist

      Explanation:

      Registration for People with Sight Impairment

      Registration for people with sight impairment is not mandatory, but it provides access to benefits and low vision services. To complete the registration process, a consultant ophthalmologist must fill out a certificate of vision impairment. There are two categories for registration: severely sight-impaired (blind) and sight-impaired/partially sighted. The severely sight-impaired category includes people with corrected visual acuity worse than 3/60 or corrected visual acuity of 3/60 to 6/60 with a contracted field of vision. It also includes people with corrected visual acuity of 6/60 or better who have a contracted field of vision, especially if it is in the lower part of the field. The sight-impaired/partially sighted category includes any person who is substantially and permanently handicapped by defective vision caused by a congenital defect, illness, or injury.

      For more information on registering for sight impairment as a disability, visit the .Gov website or the RNIB website. Additionally, the Royal College of Ophthalmologists has published a guide on low vision that may be of general interest to healthcare professionals.

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      • Consulting In General Practice
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  • Question 5 - A seasoned General Practice (GP) manager observes that GP consultations appear to have...

    Incorrect

    • A seasoned General Practice (GP) manager observes that GP consultations appear to have evolved, particularly in terms of the types of consultation and the age groups that consult the most frequently. She conducts an audit of the number and types of consultations that occurred in the past three years and compares these findings to a previous audit conducted in 2000. It is observed that there have been some significant changes, which are consistent with similar national analyses.
      What is the most probable recent trend in GP consultations concerning age groups?

      Your Answer:

      Correct Answer: Frequent attenders consult, on average, five times more than the rest of the Practice population

      Explanation:

      Changes in General Practice Consultation Trends: A Retrospective Cohort Study

      A retrospective cohort study has revealed significant changes in General Practice (GP) consultation trends, particularly in the type of consultations offered. The COVID-19 pandemic has led to a shift away from face-to-face consultations towards other means of consulting. Frequent attenders are now consulting proportionally more over time, accounting for almost half of all GP consultations and five times more than the rest of the Practice population. This trend is evident across all consultation modalities, including face-to-face. However, the proportion of consultations with frequent attenders has dropped since 2000, despite GP consultations with frequent attenders increasing from a median of 13% to 21% over the same period. Currently, one in ten GP consultations (of any type) are with frequent attenders, and these have proportionally increased in the last 20 years. Although there has been a reduction in face-to-face consultations and a significant increase in online/telephone consultations, overall appointments have continued to increase. Face-to-face consultations have reduced in number, both for GPs and other clinical staff.

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      • Consulting In General Practice
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  • Question 6 - One of your GP colleagues in their 50s asks you what impact revalidation...

    Incorrect

    • One of your GP colleagues in their 50s asks you what impact revalidation will have on their practice. What areas will be evaluated during the revalidation process?

      Your Answer:

      Correct Answer: Fitness to hold a medical licence + fitness to be on the GP Register

      Explanation:

      Understanding Revalidation for UK Doctors

      Revalidation is a process introduced in 2012 that changed the way UK doctors are licensed and certified. Previously, doctors automatically received their license to practice if they paid their annual fee and had no limitations on their registration. However, with revalidation, doctors are required to prove their fitness to practice every five years to continue working as a doctor. This process combines licensing and certification, and annual appraisals will continue as before, with a focus on progress towards the revalidation portfolio.

      The Royal College of General Practitioners (RCGP) is creating an ePortfolio for the process, which will contain various elements such as a description of work, special circumstances, previous appraisals, personal development plans, continuing professional development, significant event audits, formal complaints, probity/health statements, multi-source/colleague feedback, patient questionnaire surveys, and clinical audit/quality improvement projects.

      To meet the requirements for revalidation, doctors must earn at least 50 learning credits per year, with one credit for each hour of education. However, if the education leads to improvements in patient care, it will count as two credits. The ePortfolio will be submitted electronically for review by a Responsible Officer, who will be based in one of the 27 Area Teams. The Responsible Officer will be advised by a GP assessor and a trained lay person.

      Before recommending a doctor for revalidation, the Responsible Officer must be confident that the doctor has participated in an annual appraisal process, submitted appropriate supporting information to their appraisals, and has no unresolved issues regarding their fitness to practice. Overall, revalidation ensures that UK doctors continue to provide safe and effective care to their patients.

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      • Consulting In General Practice
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  • Question 7 - You speak with a 27-year-old care assistant who works in the local residential...

    Incorrect

    • You speak with a 27-year-old care assistant who works in the local residential care home. She has a sore throat, fever and rash. She requests antibiotics as she is eager to get back to work for her night shifts in 2 days. Her 4-year-old son recently had a course of antibiotics following a similar presentation.

      On examination, she has a fine rough feeling rash on her torso and her tongue appears red and swollen. Her observations are normal.

      Given the likely diagnosis, what advice from the options below would be most appropriate to give?

      Your Answer:

      Correct Answer: Advise her that you need to contact the Local Health Protection Agency (HPA) and she should not go into work. If she doesn't consent, confirm that you will still need to inform the HPA

      Explanation:

      Kindly request that she notifies her workplace and the Local Health Protection Agency (HPA) and arranges a discussion with them regarding her return date.

      Sharing patient information is crucial for providing safe and effective care, especially in multi-disciplinary teams. However, it is important to ensure that information is shared in a legal and ethical manner while facilitating access to those who require it. Inappropriate sharing of information can have significant consequences for the clinician-patient relationship and the wider profession. Patients generally expect some information to be shared with those involved in their care, but if they object, the information should not be disclosed unless it is justified for the public interest or the patient lacks capacity. It is important to explain the potential consequences of not sharing personal information and reach a compromise where possible.

      When sharing information, it is essential to access it to support the patient’s direct care or be satisfied that it is being shared for that purpose. Patients should be informed about how their personal information will be used, and they have the right to object. It is also crucial to ensure that anyone who receives the information understands that it is given in confidence. When sharing information with friends or relatives, it is necessary to establish the patient’s wishes and gain explicit consent. In cases where the patient lacks capacity, it is essential to consider various factors, such as the patient’s beliefs and values, before disclosing information.

      Disclosing information without the patient’s express consent is generally not allowed, except when required by law or justified in the public interest. In exceptional circumstances, such as gunshot wounds and knife injuries, the police should be informed, but personal information should not be disclosed initially. It is crucial to follow the relevant guidelines to avoid inappropriate information sharing and maintain transparency between the doctor and patient.

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      • Consulting In General Practice
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  • Question 8 - A 29-year-old man visits the General Practitioner for a consultation. He reports being...

    Incorrect

    • A 29-year-old man visits the General Practitioner for a consultation. He reports being a victim of domestic abuse by his partner.
      Which of the following choices is LEAST PROBABLE to corroborate his statement?

      Your Answer:

      Correct Answer: He had to strike the partner because she 'wound him up'

      Explanation:

      Understanding Domestic Violence: Identifying Victims and Perpetrators

      Domestic violence is a form of abusive and controlling behavior that gives the abuser power over the victim. It is not limited to heterosexual relationships and can occur in any kind of relationship. According to a survey conducted in 2012-2013, 7.1% of women and 4.4% of men reported experiencing domestic violence.

      It is crucial to correctly identify whether the patient is a victim or a perpetrator as incorrect identification can have severe consequences for the patient, their partner, and any children involved. Striking out at a partner is an action of a perpetrator, and no matter how annoying they find their partner, they are not legally allowed to hurt them. The other four options could be examples of abuse against the perpetrator.

      For those interested in learning more about the issues surrounding male victims of domestic violence, the Respect Toolkit for Work with Male Victims of Domestic Violence (2019) provides an excellent overview.

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      • Consulting In General Practice
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  • Question 9 - A father attends with his 6-year-old child. The child sustained an uncomplicated closed...

    Incorrect

    • A father attends with his 6-year-old child. The child sustained an uncomplicated closed fracture of the tibia following a playground accident and is expected to wear a cast for 8 weeks.

      The child's father says that he will need help with bathing and transport to school and wonders about financial assistance because domestic finances are tight.

      Regarding the Disability Living Allowance (DLA) for under 16s, what advice would you give him?

      Your Answer:

      Correct Answer: The child must have needed care for the preceding month to be eligible

      Explanation:

      Disability Living Allowance (DLA) and Personal Independence Payment (PIP)

      Disability Living Allowance (DLA) is a tax-free benefit that assists with the additional expenses of caring for a child who requires assistance due to a disability or health condition. The benefit is paid to the child’s parent or caregiver, such as a step-parent, guardian, grandparent, foster parent, or older sibling over the age of 18. To qualify for DLA, the child must require more day-to-day assistance than other children of the same age without a disability, and the assistance must have been necessary for at least three months and expected to continue for at least six months. DLA is made up of a care component and a mobility component, with varying rates for each.

      Personal Independence Payment (PIP) is gradually replacing DLA for individuals aged 16 or older who have not yet reached State Pension age. PIP is designed to assist with the additional expenses of living with a disability or health condition and is based on an individual’s ability to carry out daily living activities and mobility. PIP is also tax-free and is made up of two components: daily living and mobility. The daily living component is paid at either the standard or enhanced rate, while the mobility component is paid at either the standard or enhanced rate.

      Overall, both DLA and PIP are essential benefits that provide financial assistance to those who require additional support due to a disability or health condition.

    • This question is part of the following fields:

      • Consulting In General Practice
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  • Question 10 - Which one of the following statements regarding appraisal is incorrect? ...

    Incorrect

    • Which one of the following statements regarding appraisal is incorrect?

      Your Answer:

      Correct Answer: A different appraiser should conduct the appraisal each year

      Explanation:

      The Importance of Appraisal for GPs

      Appraisal is a crucial process that has been mandatory for GPs since 2002. Its primary purpose is to identify areas for development rather than performance management. With the introduction of revalidation by the GMC, appraisals have become even more important as they provide a structured system for recording progress towards revalidation and identifying development needs.

      After the Primary Care Trusts were disbanded, NHS England took on the responsibility for appraisals. The appraiser should be another GP who has been properly trained in appraisal. It is recommended that a doctor should have no more than three consecutive appraisals by the same appraiser in the same revalidation cycle. The average time commitment for appraisal is a minimum of 4.5 to 6.5 hours, including between 2 and 4 hours for preparation.

      The content of appraisal is based on the 4 key domains set out in the GMC’s Good Medical Practice document. These domains include knowledge, skills, and performance, contributing and complying with systems to protect patients, communication, partnership, and teamwork, and maintaining trust. It is essential for GPs to participate in appraisal regularly to ensure they are providing the best possible care to their patients and maintaining their professional standards.

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      • Consulting In General Practice
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