Express & Star

Exhausting day in the life of a GP

Twelve-hour days, mountains of paperwork, emergency home visits - it's all in a day's work for a GP.

Published

One doctor has opened up to the Express & Star about the increasing workload she faces, and the pressure it puts on her both at home and at the practice.

She gives us a run-down of one of her days, and then explains her fears for the future of the profession.

8.10am Arrive at work and try and log on. Computer decides it doesn't recognise my 'smart card' so turn off/on again. Not a good start to a Monday!

8.20am Finally logged on and see 31 lab reports and 11 tasks waiting – start trying to sort out the most urgent tasks before surgery starts.

8.25am Quick coffee and chat to my colleagues. Catch up briefly about their weekend and about a few staffing issues Contingency plan made as two people in same department off.

8.30am Start morning surgery. Slightly irritated to see that a patient has cancelled their online appointment for 8.40am at 8.32am, so it's too late to offer this to someone else. Morning surgery brings its usual variety – 15 patients seen between now and 11.45am. Mixture of infections, contraception issues, mental health problems. Long chat trying to convince someone to go to hospital who really needs to but refuses. Therefore plans made for them to be called back later on to check they're OK. Admitted another patient as an emergency to hospital– thorough assessment of patient, telephone call to hospital, write up notes and write referral letter – not possible in a 10-minute slot!

Life as a GP is getting harder by the day; I wanted to give a bit of an insight into what we actually do, as it is often a misunderstood role.

Ask many people (other doctors included), and they will think we spend our time seeing people with coughs and colds, and then have a long lunch break when the doors to the surgery are closed. By writing about a typical day, I hope to dispel some myths.

There are so many pressures facing general practice, and I feel one of the biggest risks to the future of the profession is poor morale. GPs are becoming demoralised, and are leaving in droves. I know of good GPs who have quit once sought-after partnerships to become locums. Not driven by greed as some journalists and politicians would have you believe, but finding themselves at risk of burnout from increasing levels of pressure.

Along with GPs leaving partnerships, there is a tidal wave of GPs heading towards retirement. There are simply not enough young GPs to replace them.

There are wider pressures too, and these affect the NHS as a whole. We are an ageing population with increasingly complex health needs that cannot be dealt with effectively in a 10-minute consultation. We are also an increasingly consumerist society and expectations are getting higher all of the time. We are very much judged by our 'customer service' rather than on our clinical acumen.

A prime example is the 'Friends and Family Test' where GPs must survey patients to see if they would recommend them to others. Alongside this are the dreaded online reviews. If we do not live up to patient expectations, for example if we do not prescribe unnecessary antibiotics, we know we run the risk of bad reviews, complaints, and even being reported to the GMC.

Does all of this pose a risk to patients? Possibly, in a few cases. However, as doctors we're used to working under pressure and making life-changing decisions in difficult circumstances.

On the whole I don't think patients are in 'danger' from their tired GPs, they just aren't getting as good a deal as we would like them to.

Various interruptions between patients, including being asked to see someone with a nasty wound infection, multiple signatures on prescriptions that patients needed urgently as they had not realised they were running out of their medications, and two lots of abnormal test results to sort out later

11.45am Prescriptions to sort out. Thirty-something electronic queries each and two baskets full of prescriptions to share between the three doctors. These contain a variety of 'easy' ones – ie signing, and complicated ones that require accessing the notes and hospital letters to find out more. Then to start on the lab result.

12.05pm Discussion with colleague about two patients they'd seen and wanted advice on.

12.10pm Back to the lab results.

12.35pm Dished out the home visits – eight between three today. I'm duty doctor, so keeping my fingers crossed that no late requests come in, as these will get done when I eventually leave surgery tonight.

12.40pm Dealing with a pile of queries and six requests for sick notes. Requests from hospital to prescribe medications for abnormal test. Next to start answering electronic tasks – various queries from patients who would like telephone calls, and a referral letter to be done.

1.15pm Read through patients' notes for visits and planned my route. Answered queries, inhaled my sandwich while I read some paperwork, quick loo break then head off.

1.30pm Visited two elderly people – one in a nursing home. Visit at nursing home written up in the home's record (if they can decipher my handwriting!). This will also need recording in GP notes.

2.15pm Back to surgery to write up visits and sort out referral letters.

2.25pm Seven more lab results appear – several of which are abnormal and complicated. Every time I start on a plan I get interrupted.

2.50pm Quick tea break with other GPs, most of which is spent discussing patients.

3pm Start surgery. By 4pm I am half an hour behind, as I have had four queries to deal with and one patient was late. Patients getting increasingly impatient and make sure they have their full allocation of time when they are called in. Ten minutes is so often not enough. My mood drastically improves when I get a thank you card.

6.35pm Finally finished afternoon surgery. Seventeen patients seen. Some quick and just needed reassurance, others much more complicated – for example chest pain, bereavement, gynaecological problems and stress. We often feel rather helpless when dealing with stress – it's commonly due to social and financial problems that we can't fix.

6.40pm Phone call to patient as I realised I'd forgotten to tell her something about her medication.

6.45pm More electronic tasks – a patient forgot to ask for their prescription earlier, two patients want me to write letters to bring forward their hospital appointment (I can try but the hospital is as stretched as we are). Various queries about system where we get paid – kind of 'payment by results' – not always convinced it improves patient care.

7pm More lab results appear – thankfully only a couple are abnormal and need messages and prescriptions. Nine letters checked and signed for hospital referrals and urgent letters to try and get social care in place for elderly people.

7.15pm Now to deal with hospital letters on patients – 48 tonight. Most need information, others need prescriptions organising, blood tests arranging or phone calls to patients.

7.30pm Quick call home to say I'll be late (again) and to say goodnight to my child. 'Are you doing my bed-time tonight Mummy?' Ouch!

7.35pm Back to the letters

7.50pm More electronic prescription queries to be answered – no time to do them earlier, and patients may be expecting to get the medication in the morning, so I'd better sort it.

8pm Finally get round to checking my emails – 15 new in my inbox. Various emails with regards to GP meetings – minutes to read, guidelines ('brief' 24-page document) to learn – that will have to wait until my brain is less frazzled.

8.30pm I'm hungry. Just realised I've forgotten to eat since my home visits. I need to go home – I start seeing patients in less than 12 hours

10pm Forms to fill in for the end of year accounts. I am now not just a doctor, I'm supposedly a businesswoman. Thank goodness for our practice manager.

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