Abstract
We currently have three GP Specialist Registrars in the practice and have a weekly joint tutorial with them. The topics for the tutorials have been chosen by the GPStRs and the ‘tutor’ rotates around the members of the practice. Last week, the chosen topic was the doctor's emergency bag and GP emergencies I ran the session with our senior practice nurse.
We started off by brain storming what we thought should be in the doctors bag, this generated a large list of equipment, paperwork and drugs. It quickly became apparent that there would not be a bag big enough to hold everything we had identified as being desirable! We debated what would be essential and during the discussion agreed that this would be dependent on where you worked. The requirements of a GP in an inner city practice such as mine would be very different than from a GP working in a rural location such as the borders of Scotland. We settled on a list we felt was appropriate for our practice, then compared this to what was actually in the doctor's bag. In our practice, we operate a duty doctor system and therefore have three doctors bag that are identically set up, centrally stocked and maintained by our nursing team. It was interesting to find that the contents of the bag contained items which we had not identified as essential but was also missing some items we had such as a glucometre and peak flow metre.
Many of you will have use of a practice doctor's bag or you may decide to buy and stock your own bag, either way you will need to think about the contents of the bag. I have found the article on the contents of the doctor's bag by patient.co.uk (KNOH 2008) and the article from the drug and therapeutics bulletin (DTB 1995) on drugs for the doctors bag very useful resources in helping decide what to put into the bag. The article by Peter Randall a GP trainer on the Isle of Wight is also worth reading (Randall).
The second half of the tutorial focused on the related topic of GP emergencies. Again, we brainstormed what we thought were the types of emergencies we would have to deal with in General Practice and once again agreed that this would vary depending on where you worked. It is likely in an inner city setting that the first responders would reach many of the emergencies long before you even got your car keys out of your pocket. However, in rural locations, the situation could be very different and you may have to care for patients for some time by yourself. This led onto a discussion about having more than just a doctor's bag in these setting but a car equipped to deal a wider range of emergencies. Indeed, in some practices this is what they have, an example is the Birkbeck Medical Group www.beepfund.org.uk/html/about.html [date last accessed 07.10.2008]. They are members of the British Association for Immediate Care (BASICS), a registered charity formed in 1977 that acts as the national coordinating body for both schemes and individuals providing Immediate Care throughout the UK. Some GPs in remote and rural areas are members of this organization, but as you can see from the BASICS website press release page www.basics.org.uk/Press%20releases.htm [date last accessed 07.10.2008], the activities of BASICS doctors is not limited to rural areas.
Having discussed what we might possibly see as GP emergencies, we finally looked at an article (Mollvan Charante et al., 2007) looking at Dutch out-of-hours care (whose model of family practice is very similar to UK) which listed the top 10 most frequently presented problems for GP cooperatives, self-referrals and ambulance referrals to Accident and Emergency departments. It was interesting to see that the emergencies we had identified did not feature on the cooperatives list but instead it was similar to what we see every day in General Practice.