My partners and I are responsible for running our practice across three different sites and this morning I’m working at our smallest surgery; a tiny bungalow on a residential road in York. It may now be one of the smallest branch surgeries in the city but we’re getting busier by the day, with swelling numbers.
When I first started in 1989, our practice as a whole had slightly over 6,000 patients, but we now have 23,000 and counting. This is largely because we look after the majority of the students at the university, with a purpose-built health centre on campus and another surgery in a neighbouring residential area in the south-east quarter of York.
I’m very lucky that the surgery I’m at this morning has a great community feel; some of the patients know each other and treat the receptionist as a friend, and having grown up in the local area, some of my patients are old school friends or know me from when I was a child, playing in my village all those years ago!
I pour my first work coffee of the day and switch on the computer, keeping my fingers crossed that it’s behaving itself today.
It takes 20 minutes to fully log in to all the different systems I will need for the morning. I have a “smartcard” to log in to the securely-protected patient record medical system, and I start up the document manager, email system and log into the local hospital information system – if it will let me, it can be a bit temperamental sometimes.
Already by 8.45am, I have more than 30 documents to look at and process, more than 20 lab results of blood tests, urine infection and swab results, messages to phone patients or arrange further treatment for them, and a short list of repeat prescription queries popping up.
Surgery starts in 15 minutes and all appointments are fully booked. For me, the patients are why I became a doctor. It is the face to face interaction – listening, understanding, examining and helping individuals’ health and related problems – that matters so much. Our patients don’t see or particularly care about the back-office work. When a patient is ill, all they want and deserve is effective, efficient, personal care. My main priority every day is to ensure we can provide that.
I call in my first patient, and, despite the pressure on my time I try to give my full attention. With the few minutes I have with them, I explore all their symptoms in order to reach a diagnosis. This can be incredibly difficult if a patient has multiple symptoms or if they have something difficult to discuss – as their doctor I want to be there to listen and give them the time they need, but I am also often aware that I have a full waiting room also in need of my care.
This morning I see around 15 patients, many of whom have seasonally-related chest infections. Some of my elderly patients are prone to infections as they have chronic lung disease, which is particularly worrying at this time of year, and one patient has severe, ongoing back and knee problems, where we continually have to juggle treatments which can be risky to the stomach with the need to keep the pain under control.
After each patient has left, I need to complete the computer record so that I can pass on relevant information, record important findings and measurements such as blood pressure and weight. If a referral to another service needs doing, I try to do it at the time, but I may well have run past the ten minute slot by then and I hate to keep patients waiting.
It is difficult to balance time with patient need. General practice is currently experiencing a workload crisis caused by rising patient demand, especially from an ageing society and those needing more complex care. The standard 10-minute appointment for these patients is simply not enough, yet increasing the time available for all the patients a GP sees each day will have yet another severe knock on effect of more delays in getting an appointment.
The truth is though that with the increasing demand and diminishing resources, GPs are forever running out of time, out of space, and out of energy; a concern repeatedly raised by the British Medical Association which is calling for the long-term, sustainable investment needed in GPs, practice staff and premises so we can deliver the care our patients deserve.
After grabbing another quick coffee, I head back to the computer. More tasks, messages, prescription requests and visit requests have made their way to my inboxes. I try to process everything as quickly but carefully as possible. Every minute really does count as the day is still full.
After morning surgery, I make a home visit to a patient who had a stroke early last year and has other ongoing health problems. His children are working tirelessly to look after him and a social service carer visits every day. He’s very lucky in that respect, but understandably he doesn’t always consider himself so. We talk about his love for writing which he unfortunately struggles to do since his stroke, and still despite everything he laughs and jokes with me and his daughter when I dare to suggest he get a computer. It’s not a prospect he likes.
I get back to the surgery and the clock ticks on closer to midday. There may be time to wolf down a quick cup of tea and a soup but my priority during lunch today is a practice management meeting to discuss plans to offer consultations using IT including Skype and interactive email, probably video consultations also. As you can imagine, the planning for this is considerable and we’ve already had to squeeze in several meetings about it this week.
I finish some of this morning’s paperwork, grab my lunch and head over to the meeting. Already I’m thinking ahead to afternoon surgery, the patients I’ll see and the remaining paperwork that I must get done tonight.
• Dr John Lethem is a GP from York.