Making the change from what may have been several years in hospital medicine as a junior doctor to becoming a GP registrar can take some getting used to. So what can you expect once you become a registrar?

Settling in

Apart from the obvious differences in setting and the range of patients seen, there are changes in the level of responsibility and autonomy you have. Although you will initially be seeing patients with your trainer, you will very quickly find you have your own booked surgeries, and you will largely be working independently (although with help close at hand whenever you need it). This can be both daunting and very satisfying – you’ll be amazed at both how much you do and don’t know! One of the most pleasant changes from hospital medicine is the continuity of seeing patients over a long period of time, and getting to know them. Most registrars also love the freedom of not having a pager after so long.

Practice Routine

You will soon find out that the work day is slightly different in practice compared to in hospital. No more starting the day with a long ward round and then working through the morning and perhaps a clinic in the afternoon – interspersed with trips to the ward to resite cannulas and complete TTOs. Instead, you are likely to have a morning and afternoon surgery, with plenty of paperwork in between, some home visits, the odd tutorial and regular practice meetings. You will soon find out which days you are on call (home visits etc.), and which clinics happen on which days (baby clinic, smear clinic, diabetic clinic, COPD clinic etc.).

Working with the team.

Finally, although you will be in your room seeing your own patients a lot of the time, you will find that in primary care there is a large team of staff with various skills and roles that you have to fit into. You need to find out how to make the best use of the resources available. Some of the members of the team include:

Practice Manager	Very important member of the team! Will sort out your pay, training on practice systems, may be involved in sorting out contracts, expense claims, study leave and rota. Normally involved in keeping an eye on progress with QOF points.
Receptionists	Practices could not run without good receptionists. They will help you locate the right forms, supplies for your room, take home visit requests and send you messages relating to your list and patients. They will also be responsible for letting patients know when you are going to be videoing or having joint surgeries for your assessments. Be nice to them, and they may even make you a nice cup of tea!
Practice Nurse	Most practices now have nurse led clinics for various things – CHD, COPD, diabetes, asthma etc. May also see patients with minor ailments, as well as dealing with removal of sutures, immunisations, and assisting in minor surgery.
Healthcare Support Worker	Many practice employ a HCSW to take bloods, and help the practice nurses with clinics etc.
District Nurses	May be attached or directly employed by the practice, usually involved in care of terminally ill patients, community management of DVT, care of housebound patients.
Health Visitors	Involved in child health surveillance, including developmental assessments, hearing assessments and home visits to children and new mothers.
Practice Secretary	Where would you be without someone to type and send all your dictated referral letters? Probably still at surgery until late. In some practices you will type your own referrals, so there may not be a secretary, or they may have other duties.
Other doctors	Remember that your trainer is not the only one that you can learn from. The other doctors may be involved formally or informally, and should be able to offer help and advice when you are unsure of a diagnosis or when to refer.