Not getting the complexity
The GP misses the point of the risk identified for a patient on renal-affecting medications being in a fluid-losing state. There's a little bit of credit for arranging the FIT and recognising the potential cancer risk, although given the time invested, there was further capacity to explain this further and the opportunity missed- notice the GP seems to address the dehydration questions as an afterthought and the patient is left a little unsettled by the lack of apparent organised approach to the plan.
Get a feel for your consultation length and ask yourself: Do I understand the complexity here?
The SCA is designed to assess Clinical Management and Medical Complexity- if you feel the explanation is too simplistic and straightforward, what might you have missed?
Struggling candidates may over-complicate and look for a hidden agenda in every case. Remember Role Players (and most patients) will respond if asked about other issues not yet discussed- you can take their answer as genuine if you've asked the direct question!
The crux of this case is not being distracted by the patient concerns of diverticulitis and not dismissing the symptoms as infection, nor jumping to conclusions that it must be cancer. It's about balancing the medium term management with the acute risks of kidney injury.
SCA Feedback Statements
Inappropriate or inadequate arrangements for follow-up continuity and or safety netting
Examiners felt that your follow-up arrangements were not adequate or that you did not ensure that there was an appropriate safety net.
Making arrangements for follow-up demonstrates your commitment to the continuity of care of patients. It shows that you are prepared to take responsibility for managing the ongoing presentation of the condition until the problem has been resolved. However, inappropriate or unrealistic follow-up is unhelpful both for the index patient and for other patients who may be unable to access their GP, with limited appointment availability.
Safety-netting describes the information you should be giving to each patient about what to expect, including a time scale if appropriate, and what to do if symptoms get worse or develop in some unexpected way. However, safety-netting may cause unnecessary alarm if performed without care.
For example, having diagnosed upper abdominal pain as simple indigestion, consider how a safety net that suggests going to A&E if it recurs ‘in case it is your heart’ might be received.
Suggestion
Consider how you end your consultations. Is it always with a safety net and if so, is that appropriately tailored to the consultation? Be aware of the literature surrounding the benefits of continuity of care in GP and discuss the systems that enable this in your practice, with the team. Notice if you are booking a follow-up and consider if this is necessary or practical.