Dr Krystyna de Lange’s top tips for finishing up at a practice and handing over. This time of the year signals a change of practices for many of us. Here is a list of my top tips for finishing up at a practice and handing over. Let your regular patients know a couple of months prior. After 6-12 months in a practice you are sure to have built up some strong relationships. Whilst it can seem hard “breaking up” with these patients, it will be easier to tell them in person than have them calling up after you have left only to be told you no longer work there. Explain to your patients that moving practices is a regular part of training. The norm is that patients do not follow registrars otherwise training practices lose patients often and would have an unsustainable mobile patient base. Patients feel better once they understand this. You may have the option of returning in the future. For those regulars you have built a strong therapeutic relationship with it may be worthwhile thinking about which other GP in the practice they would be suited to. Be positive in your explanation of a good plan for them, “I have been thinking about this and I feel that Dr X would be ideal to take over your care. She has a special interest in women’s health and is very approachable. I will make sure she is up to date on your progress when I leave”. Any patients that are more complex or in the midst of work up may need a formal verbal and or written handover to a colleague. There is a great potential for error and inappropriate doubling up of investigations if patients are not handed over well so make this a priority. Start a list of these patients on your desktop and add to it over the next month or two. Include your clinical reasoning and where you are up to with investigations and management. In your final week or two, sit down with each colleague who is receiving one of your patients and go through the list. Obviously you cannot do a formal hand over for every single patient you have seen. And for many patients it won’t be necessary. But documentation is key here. Get on top of your recall list. Which patients are you still chasing for investigation results or follow up? You want this list finalised as much as possible before leaving. Make a few calls if needed. Chat to your supervisor about who will manage this list once you’ve gone. Remember being an intern and getting dumped with a hundred discharge summaries from the previous rotation for patients you’ve never even met? Don’t do this to your colleagues. Get this list down. And for those few remaining when you leave, hand them over to ensure they don’t fall through the cracks. Add new recalls for patients you are concerned may not follow through with a referral or test. Document the reason for the referral so it is clear. Who will be checking your inbox once you are gone? Check with your supervisor or practice manager to ensure there will be a streamlined method e.g. all results are forwarded on to a colleague in the practice or someone is assigned to regularly check it. In your final week it may be worthwhile handing over some patients in person. These tend to be sick patients or visual things you want to monitor e.g. a wound, rash, asthmatic or child with bronchiolitis. If you see these patients in your last week and you know they will be coming back for review after you have gone then ask the colleague who will be following it up to come in to the consult. Organise your room. Gather your resources and starting cleaning out those drawers. Make sure you don’t leave anything important behind. Get a copy of all those precious autofills! Most of you will be feeling a mix of emotions in the lead up to a practice change. It is the nature of training in medicine. I have now worked in seven different workplaces since finishing university and most of you would be similar. Whilst a change can be exciting, it inevitably brings some nerves about starting fresh, learning new systems, meeting new people and proving yourself all over again. But with new placements brings new opportunities. Embrace the learning potential at every corner, pick your supervisor’s brain, and take some learning with you from every member of the team. Merry Christmas, happy new year, and best wishes for a smooth transition into your next general practice term. Krystyna da Lange GPTQ Registrar Liaison Officer
