I have been asked a few times to write a blog post about what a GP does all day. It has taken me this long to write it as I have struggled to document the realities of general practice in a succinct way, but here goes…
To start with the job isn’t just a list of 10 minute appointments. I start the morning with my first patient at 8.30am but am usually in around 7.50am after dropping the kids off at the childminders. The time before seeing patients is useful to get on and sign some repeat prescriptions and get through some admin. There is usually a cup or tea/coffee on my desk and I send an instant message to my close GP colleagues to say ‘morning’ and see how they are. My little ‘base site’ is one of nine surgeries across our large nine site practice. I might have nurses, other GPs, HCAs, trainees and other clinicians working alongside me during the session…or I might not. All depends on the rota and current staffing levels.
Take this morning as an example, I had fourteen 10 minute appointments booked in, a mix of follow-ups and new patients. There was a real mix; long term anxiety, chronic knee pain, new left sided abdominal pain and some gynae problems to name a few. Being a GP, I really do see a mixed bag of symptoms and conditions and you never know what is coming through your door.
So what do I do after my morning surgery of fourteen face to face patients? Let’s say I finish seeing patients at around 11.30am, I use the next half hour for some more admin (more on this later) and then once midday comes around I check out the visit list and make sure they are allocated to the appropriate clinician. Home visits are reserved for the patients who are bed bound, very frail or very unwell and the number per day can vary hugely.
So, off I toddle to my local home visit – this can take anything from 15 minutes to an hour.
Maybe I get back around 1ish having picked up a quick lunch from the local sarnie shop. We start our afternoon surgery at around 2.30pm, so an hour and a half break, right? Nooooooo.
The next hour will be filled with ‘GP admin’. So what is this admin I keep going on about? There will be referrals to write, some GPs dictate these and some will type them. There might be referrals to the local hospital, mental health team or ultrasound scan requests to send for example. Repeat prescriptions need to be sorted, usually a pile of paper scripts and a list of electronic prescriptions to sign. Next, I might move on to some phone calls, I like to follow up my own patients – if a patient has a chest x-ray that needs discussion then this is the opportunity to contact the patient. What else?… some insurance reports to write, scanned letters like scan results or discharge letters to review and file, blood tests to look at and action, fit notes to issue, hospital colleagues to contact, prescription queries to deal with or clinical queries from other staff to address.
Somewhere during this ‘lunchtime’, I will try to catch up with my GP colleagues. We try to have 30-60 mins per day of downtime for a general chat, debrief and giggle. It is also a really useful opportunity to bring up any conundrums or confusing cases to seek some advice or another viewpoint. Some weeks we have meetings scheduled during this timeframe – health visitor safeguarding meetings, palliative care meetings or significant event meetings to name a few.
At 2.30pm I start my afternoon surgery which generally finishes just after 5 pm. On a good day, I can leave around 5.40pm so I can pick up the kids and get home. Some GPs are staying well beyond 8pm to get everything done, some have remote access at home to keep on top of their admin. On a Friday I leave about 6.30pm or so as I don’t need to get home to pick up the children. Every couple of weeks, I will be ‘on call’, this means I will be the GP in charge of doing any ‘late visits’ – this means any urgent visits that are requested after lunch are my responsibility and I will do them after my afternoon surgery. I was late call earlier in the week and had six phone calls to do which were mostly prescription queries and one home visit to attend to.
So that is a typical ‘routine’ day. I won’t go into all the different patients I might see, from simple rashes to very complex elderly patients with several health conditions…Maybe for a future blog, suffice to say the clinical presentations are varied!
What is ‘urgent care’? At my practice, we GPs tend to do a whole day of urgent care. The clinic is full of patients needing/requesting same day appointments. Our urgent clinics are staffed by a variety of clinicians – a GP doing face to face consultations, a GP doing telephone triage, a practice nurse, an advanced nurse practitioner (ANP) and an urgent care practitioner (UCP) or two. Patients will have a variety of problems from simple coughs and colds to back pain, acute mental distress or urgent prescription queries. We do not promise a patient will see a GP and try to match the patient with the appropriate clinician on the day.
These days can be manic, the clinics are always full and we can see some very sick people. We tend to run ‘late’ so we try to warn patients there may be a wait but they will be seen. So why do we run late? Many problems aren’t a simple fix. Admitting someone to the hospital takes time, having to ring the bed manager or doctor on call, arranging transport after having a lengthy discussion with the patient/family about why a hospital stay is recommended. Also, the GP may be reviewing nurse/UCP patients as well as seeing their own.
Now I am a partner I also have other things to consider; how are my staff, anything they want to let me know about? Sorting complaints, ensuring the trainees are OK, replying to emails (so many emails!)… I am also comms lead – how is social media looking, are the waiting room TV screens up to date, do we need to sort new posters/campaigns? Liaising with IT/HR managers and local team leaders… The list goes on.
What other roles might you see us doing in general practice? Some days I spend half a day at a local nursing home, other weeks I do a round at a neurological rehabilitation unit. I am part of our practice ‘anticoagulation team’ so I monitor the warfarin clinics and authorise the dosing schedules when needed during a routine surgery. We teach medical students, supervise GP trainees, attend meetings at the hospital, medical school or CCG and get involved in research. No two weeks are the same.
I write this post on a Friday evening half watching masterchef Australia with a glass of wine in hand. It has been a busy week. I love my job, I love my colleagues. Being a GP is hard, it is busy but my goodness it is an honour. I get let into the personal lives of my patients; they trust me, they rely on me and they respect me. We do our best for you, sometimes we get it wrong but I assure you we are doing our best.