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At the heart of general practice since 1960

Brought to book by changes in the air

Rob Finch talks to Britain's busiest GP about how she struggles to cope with the workload of three

Stepping through the automatic doors into the ultra-modern reception of Dr Vanessa Doel's surgery, it is hard to believe her practice is at breaking point.

But the plush surroundings of the St Albans Medical Centre in Bulwell, Nottingham, mask a crisis.

With more than 6,000 patients on her list, Dr Doel is arguably Britain's busiest GP. She often works 18-hour days and comes in most weekends. Her practice is in an area blighted by industrial decline, spiralling violent crime and substance abuse.

The patients, many of whom used to work at the nearby Player's cigarette factory, suffer a multitude of chronic diseases and co-morbidities.

Finding a new partner has proved almost impossible. Getting locum cover has been a nightmare. And with a list size usually handled by at least three GPs, comes three times the level of paperwork.

Dr Doel said her nightmare began shortly after walking into her new £1.1 million premises last October.

Almost immediately her partner, Dr Mike Grant, took long-term sick leave. He then retired, leaving Dr Doel with sole responsibility for the already short-staffed practice.

'In November I was literally having to get in to work long before surgery opened and stay there until gone 8.30 just to get things done,' she said. 'To get any locum agency to provide us with cover was a no-go really ­ they just weren't available.'

Then in December, the situation took a turn for the worse when Dr Doel was bedridden with flu.

Finally Nottingham City PCT took action. Until then it had ignored her plight, saying the practice was 'a victim of its own success'. It now parachuted in locums. But Dr Doel still found herself doing telephone triage from her sickbed.

Her husband ­ who gave up a company directorship to be practice manager ­ also took home prescriptions for her to sign. 'I feel like I've compromised my family, but fortunately I have a very understanding partner,' she said.

Dr Doel said dealing with endless sicknotes, referral letters and mountains of forms, plus ridiculous red tape, were her biggest problems.

Every six weeks, for instance, she faces the farcical situation of having to resubmit her case to the PCT for why her practice should be allowed to continue with its 'closed list' policy.

'I'm a bit of everything; a manager cum accountant cum lawyer ­ everybody's counsellor, everybody's social worker,' Dr Doel said. 'When I go to the supermarket across the road I cannot go up and down the aisles without feeling that I should have my table and chair in there and sit down and say "hey everybody I'm here".'

After the darkest days of winter, Dr Doel's situation is starting to look brighter.

After spending months trying to attract locums to do short-term work she has finally found some longer-term cover.

'It will get better and anyone out there who is looking for a job ­ we're not bad people to work for,' she joked.

Dr Doel has also been able to turn her attention to the quality framework ­ albeit only at weekends.

She aimed for 900 points but not surprisingly has fallen behind. Achievement is on track for nearer 600.

'Practices were told to aim as high as possible. That's OK if you've got a full complement ­ if you haven't its nigh on impossible,' she says.

'When we had our Q&O visit I was told we were doing well in the face of such adverse circumstances.'

Through it all, patients have been supportive ­ even though they have to wait up to four weeks for an appointment. When they do get to see her, Dr Doel gives 15-minute consultations, to ensure all their problems are covered.

Dr Doel, somehow, has coped. She says: 'I get home and I'm knackered ­ but when I sleep, I sleep.'

An 18-hour day

5.00am wake up, grab a coffee, open post and start paperwork ­ test results, prescriptions, referrals

7.30am arrive at surgery and start work on computer

8.00am take calls and do home visits while out-of-hours service goes 'off-line'

8.30am start surgery, husband takes kids to

school

11.30am surgery supposed to end

12 noon see last patients due to overrunning; start home visits ­ usually four, but can be as many as 10

3.00pm start surgery again, husband picks up kids

6.00pm surgery officially ends ­ overrunning because nurses come for advice and prescriptions to be signed, plus extras and doing sicknotes

7.15pm more home visits

8.30pm home time ­ kids usually in bed by the time I get back; grab something to eat then sign up to 200 prescriptions

11.00pm Lights out ­

time for bed

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