A day in the life: GP

A Day in the life Blog?

I was on call on Monday.?

We’re short-staffed due to struggling to recruit.?

I was awake before the 06:30 alarm, full of trepidation for what another NHS General Practice Monday would bring.??

Having left the family at home searching for bits of PE kit, I arrived at work at 07:15 to crack on with clearing the daily admin load of repeat prescriptions, test results and letters from hospitals, doing both my share and the share of colleagues with covid.?

Morning emergency surgery started at 08:30 and consisted of a relentless run of phone triage, digital consultations, and a load of face-to-face appointments, often juggling a few at a time and managing 4 different digital products to handle outgoing and incoming communication as well as our practice clinical system. It feels like air traffic control at times. I simply don’t have time to spin all those plates safely. Add to that the knocks on the door or screen messages for advice and support and the usual Monday morning practice management issues that partnership brings, and the morning quickly became the afternoon.?

?A delayed home visit due to traffic saw me back at my desk at 2 pm, smiling at how easily I was finding the intermittent fasting diet I’m on. Lunch? Lunch is for wimps. I simply don’t have time for it. I normally enjoy my routine afternoon face-to-face surgeries. However, I’m not covering the “on-call” for 7500 patients at the same time. Any patient with a perceived urgent need is added to the dreaded afternoon calls list from 12:00-18:30 (when we theoretically close). All these interactions need a triage decision and communication with the patient, and many will need to be seen face-to-face.?

So, I spent the next few hours trying to concentrate on the patients who had waited a couple of weeks or longer to see the GP of their choice for a routine matter whilst keeping one eye on the potential Armageddon on our appointment book. I now apologise to anyone who felt their joint injection was rushed or that I was a bit cranky whilst reviewing the CT scan they had in a local hospital where their follow-up appointment is now after next Easter. I simply didn’t have the time to be the GP I’m proud of being – or at least used to be. After navigating an overworked, overcomplicated system to try to place a poorly complex patient anywhere but a hospital bed and seeing too many hot kids whose parents hadn’t even considered Covid as a diagnosis, I was feeling a bit broken by the time the phones finally went over to our out of hours provider. And breathe.?

I rang my mum on the way home at 19:00, feeling slightly giddy with a sense of chaotic achievement at simply getting through another 11-hour-plus Monday. The British Medical Association and others say that 25-28 patient interactions a day is considered safe for a GP. But what is an interaction? Simply measuring those consultations that required a slot on our appointment book I did 58 interactions on Monday. This doesn’t include the informal advice given to the registrar or nursing colleagues or the 50+ repeat prescriptions checked and issued, the 100+ results checked, actioned, and filed or the 50+ paper and electronic letters read, actioned, and filed.?

Sat with a beer (after THAT Monday, you better believe it) watching the rain wash away distant memories of our summer holiday, I reflected on how sustainable this workload is. I’m lucky. I only work 2 days a week in the practice so I’m able to build resilience during a varied working week. A recent diagnosis of high blood pressure has made me consider whether I can even continue with that level of exposure. I cannot escape the fact that I’m not the GP I want to be. I simply don’t have the time to be that GP. That’s a worry for me, my practice, and my patients.?

After 25 years of listening to politicians of any political colour tell us what they think the NHS needs, it’s very clear to me and my colleagues that the holy grail, the one thing that would make us better, safer, and happier – and that NO politician has ever tried to give us – is TIME.?

We need more time to care.