Teamwork: Working with Colleagues

What happened: A registrar in their ST2 year referred a 68-year-old with mild-to-moderate frailty to the medical outpatient clinic for "falls and increasing dependence." The hospital wrote back: "No acute medical cause found. Suggest community occupational therapy and physiotherapy assessment."

What the trainee learned: Both the OT and the first-contact physiotherapist were available through the PCN and could have assessed the patient at home. The hospital referral delayed things by 8 weeks and added no clinical value. The lesson: always ask yourself first whether your own PCN team can manage this before referring outwards.

The habit that helps: Keep a mental checklist of your PCN team on your desk. Before every hospital referral, run through it: "Can physio, OT, pharmacist, or community nursing handle this first?"

What happened: A registrar referred a patient to the social prescribing link worker for loneliness and low mood. Three months later the patient came back, still struggling. The social prescriber had tried to contact them but had the wrong mobile number. Nobody had noticed the referral had not been completed.

What the trainee learned: A referral is not complete when you click send. It is complete when you know the patient has been seen and helped. Build in a review date. Add a task in the system: "Check social prescriber referral in 4 weeks." If nothing has happened, find out why.

The habit that helps: After every referral, add a follow-up task to the patient's record — even just "check referred to SP — confirm contact made."

What happened: A registrar with a patient on 12 medications (many started by secondary care) made dose adjustments during consultations without involving the practice pharmacist. The patient later had a preventable medication interaction identified — by the community pharmacist, who flagged it to the GP partner.

What the trainee learned: The clinical pharmacist in your practice is an independent prescriber with deep expertise in polypharmacy. They are not a checker. They are a clinical colleague. Patients with 5 or more medications benefit from a structured medication review — and that is the pharmacist's domain, not the GP's.

The habit that helps: Flag all patients on 5+ medications for a structured medication review with the pharmacist at least annually. When you see a complex medication list in a consultation — and feel out of your depth — message the pharmacist directly.

What happened: A registrar saw a young mum repeatedly over 4 months for minor illnesses in her toddler. Each time, the mum seemed stressed and tearful. The registrar offered support and prescribed, but never thought to involve the health visitor. At the 5th appointment, a colleague who happened to see the notes flagged a safeguarding concern that had been building unnoticed.

What the trainee learned: The health visitor holds a level of knowledge about young families that no GP appointment can replicate. They visit the home. They know the family. They see the child in their own environment. When a young family is struggling — even without a specific safeguarding threshold — involving the health visitor early is almost always the right call.

The habit that helps: If a child under 5 is presenting repeatedly with minor illness and the family feels chaotic or stressed — ask yourself: "Has the health visitor been involved recently?" If not, make the referral.

What happened: A registrar prescribed an antidepressant to a recently widowed 74-year-old man who had come in feeling low, tired, and unmotivated. He had a healthy grief response to losing his wife of 47 years, plus social isolation. The antidepressant provided no benefit. He came back three more times in the next two months.

What the trainee learned: Prescribing for loneliness does not cure loneliness. Social prescribing — community activities, bereavement groups, volunteer visiting schemes — is what this patient needed. The social prescribing link worker can arrange this. The GP cannot, not in a 10-minute appointment.

The habit that helps: Before prescribing for any low mood presentation — ask yourself: "Is there a social cause here that a community intervention could address better than medication?"

A GP practice is a single organisation serving a registered patient list. A Primary Care Network (PCN) is a group of GP practices working together, covering a population of 30,000–50,000 patients. PCNs are the vehicle through which ARRS funding is accessed, meaning it is usually the PCN (not the individual practice) that employs roles like social prescribers, pharmacists, and paramedics — though those staff work within individual practices.

You do not need to know all 18 by name. But you should know the most common and clinically important ones: clinical pharmacist, paramedic, social prescribing link worker, first-contact physiotherapist, mental health practitioner, physician associate, care co-ordinator, health and wellbeing coach. For each one, know one or two clinical situations where you would appropriately refer to them.

Health visitors work with children aged 0–5 and their families. They are a first-line, non-statutory support — ideal for developmental concerns, postnatal mental health, infant feeding difficulties, or a young family under stress without a clear child protection threshold. Social services (children's) are the right escalation when there is a safeguarding concern that cannot be managed through health visitor support alone. If in doubt — and the child is not at immediate risk — a conversation with the health visitor is often the right first step.

Explore the reason. Sometimes it is about not wanting to be "passed on" — address this directly: "I am not sending you away — I will still be here for you. But [team member] can offer you something I cannot." If the refusal relates to cost, stigma, logistics, or past negative experiences, address these specifically. Ultimately, if the patient declines after a full explanation, respect their autonomy, safety-net appropriately, and document the discussion.

Yes — in most practices, referral to community MDT members (pharmacist, social prescriber, physio) is part of normal GP work and does not require separate trainer sign-off. Secondary care referrals (two-week-wait, outpatient) may need to go through the GP's name while you are in training — check your practice protocol. Your trainer is always a resource if you are unsure whether a referral is appropriate.