John Lethem: Part two of a day in a life of a GP surgery on NHS frontline

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I GLANCE at my watch; after a busy morning with patients and an important lunchtime meeting, it’s time for afternoon surgery. As I’m preparing I receive an urgent call from Children’s Social Services regarding a safeguarding issue.

There is a level of risk to a child’s physical, emotional and mental health; the call requires time and my full attention, but cooperation and co-ordination like this can be vital to a child’s well-being as has been proven in previous situations I’ve faced.

Dealing with the call takes about 20 minutes and I need to start seeing patients straight away. I have the last slurp of my now cold coffee and get ready for my first consultation.

For me, continuity of care is vital. So before I call the first patient in, I skim through their records; the notes I’ve written down are important as they highlight any major problems, medication changes and test results but the picture that forms in my head when the patient walks through the door is worth a thousand words. There is something in my memory that clicks, and it is this above anything that helps the conversation pick up where it left off.

As I see 30 or 40 patients every day, ten minutes for each, it’s important that I make them feel at ease quickly. Patients have often been worrying about an issue for a while but don’t necessarily know what to say in such a small amount of time. Continuity of care means we can establish a good doctor-patient relationship where they feel comfortable discussing issues.

Afternoon surgery starts well but a series of complex health conditions mean I fall behind schedule; I have a patient with newly-diagnosed asthma who needs time for me to explain the use of inhalers; I need to discuss and tweak a complicated treatment schedule to make life more comfortable for a patient suffering from severe migraines; and I need time to discuss treatment with a patient suffering from a mental illness. These are all incredibly important issues that must be dealt with immediately and require my full focus but even after over 20 years as a GP, it’s difficult not to feel stressed when you hear the ticking clock on the wall and think about the busy waiting room outside.

I understand entirely why our younger patients are becoming frustrated at the lack of appointments and delays getting the treatment they need. That’s why at our university health centre we offer a ‘stay and wait’ service every day. It does what it says on the tin and allows us to deal with everyone who has a problem on that day.

Despite the increasing pressure on GPs, every patient should be treated like they’re the first person the doctor’s seen that day, but the reality is that doctors need more support and sustainable investment to help provide the best possible care.

It’s four o’clock now, and like many GPs, I have worked from 8.30am without a break. Sadly the increasing demand means this is becoming ‘the norm’ for GPs, with many struggling to cope with the rising workloads and cuts in funding.

The increasing pressure has led to delays for patients and has impacted greatly on staff morale and recruitment. A recent survey from the British Medical Association showed that six out of 10 GPs were considering early retirement, while a quarter were considering quitting the medical profession altogether, due to the pressures they are under.

The picture’s not much better when we look at those entering the profession; Yorkshire and Humber was one of the worst areas for unfilled GP trainee vacancies last year, with 70 out of 299 available posts left vacant last year.

We need long-term, sustainable investment in practice funding so we can increase our workforce and provide the services that will make a real difference to patients.

Time ticks on, and with every patient I see, there’s another waiting. Throughout the day I continually check my emails for updated results and information on patients, and this afternoon I receive a critical blood result for a patient undergoing treatment for cancer.

A particular chemical was dangerously out of balance and nearing the point where a drip may be needed if we are unable to increase the levels of medication by mouth.

Out of the four specialists I tried at the hospital, I was able to get the information I needed from two of them. I could then phone the patient and let him know that a prescription for sachets to take by mouth at home had been faxed to the local pharmacy. This would help make him feel better and respond to ongoing treatment, hopefully avoiding the need for him to go to hospital.

After I’ve seen all the patients for that day and have completed records and prescription requests, I’m finally finished. I pack up my bag and head home, but I’m already thinking about what lies ahead tomorrow.

Dr John Lethem is a GP from York. This is part-two of a series charting a day in the life of a family doctor.