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GPs buried under trusts' workload dump

Life as a new GP partner

Dr Phil Smith describes a typical day in his practice after recently taking on partnership


Profile: Dr Phil Smith

dr smith philip 3x2

dr smith philip 3x2

Career 2006: Qualified in medicine

2013: ST2–ST3 placement at north-west London practice

2014: Salaried GP at the practice 

2016: Joined the partnership

Roles GP partner and practice lead on chronic disease, homelessness and education. Applying to become GP trainer

Hours worked Six clinical sessions per week, plus extended access commitments

07.45

I arrive at the surgery and catch up on e-mails. Since becoming a partner, I allow at least half an hour for admin before morning clinic. There are usually some patient letters, requests and queries that need a clinician, and it helps the management staff to sort them first thing.

08.20

The first clinical session gets under way. This morning I’m on triage duty at the front desk, a system I recently helped set up to improve access. The second patient I see is annoyed: we’re not winning with his asthma and it is affecting his job. After taking a brief history I book him in for further investigations with our physician associate (PA), who leads on respiratory work locally. I’m struck by how my approach has changed since becoming a partner; as a salaried GP I would have managed the patient myself, whereas now I am more aware of the expertise available for the practice to draw on and more confident to make use of it. This way, the patient benefits from being seen quickly for a thorough assessment, while GP time is freed up to see sicker patients.

11.30

Clinic over, I go back into admin mode. The first job is to call an engineer about the broken air conditioning; the practice manager is away today so it’s a case of stepping up to the plate. Our partnership rents the premises – I am a joint leaseholder – and it was a surprise when I transitioned to partnership to realise how much extra responsibility this involves, maintaining everything from blood pressure monitors to toilet roll holders and security door codes.

12.00

I chair a meeting with the CCG diabetes management team to review our complex diabetes patients. Since becoming a partner, I now lead the practice’s work on diabetes, cancer, palliative care and enhanced services, which includes working closely with 12 neighbouring practices to pool resources and shape local pathways. The responsibility can be quite daunting, but my senior partners are very experienced with commissioning, and forthcoming with support and advice.

14.00

I grab a sandwich at my desk while updating some enhanced service work. Being the practice co-lead has made me much more attuned to getting the most out of each patient’s visit, both in terms of patient care and practice income.

15.00

During afternoon surgery, I discuss a tricky case with the GPST3 I’m supervising. A district nurse has requested a home visit to a palliative care patient; we agree the likely outcome and arrange hospital admission instead, discussing the grey areas of palliative care and the limits of our practice.

Becoming an education lead has been the most rewarding aspect of partnership. I enjoy the interaction with students and trainees and seeing them progress; it also strengthens confidence in my judgment, and my value to the practice.

18.00

I head to our fortnightly partners’ meeting. We are to lose two registrars at the end of the month, so we discuss how best to staff clinics and on-calls, and who will supervise our new FY2 arrival.

We also discuss a plan to hire two new PAs. We have to consider what impact this will have, not only on the overall budget, but also the profit for partners.

It has been a steep learning curve picking up the business side of partnership, and how we interact with commissioners. When my partners discuss meetings with the CCG and various committees, I often think, ‘I don’t have a clue!’ It’s quite humbling – but also reassuring – that senior colleagues have so much knowledge to pass on.

20.00

I finish my notes and referrals and find I’m last to leave. In the car, I reflect on the meeting and start to consider new ways to join up care across our neighbourhood. I get a real sense of satisfaction knowing I’m now part of the practice ‘family’ and looking forward to sharing in its future.

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Readers' comments (15)

  • Azeem Majeed

    Thanks for your article Phil. It's good to get the perspective of a new GP partner.

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  • National Hopeless Service

    Always find it strange/fascinating that some GPs are proud of working twelve hour days and having lunch at the desk. No wonder there is a recruitment crisis.

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  • Cobblers

    Young and macho. Still keen to do the hours and brag about it.

    Try that aged 55 and see what you think.

    Remember that it is you first, then family (remember them?), then the practice.

    Not the other way round.

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  • exactly cobblers. Should always be you first, then family and then job :)

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  • Vinci Ho

    (1) Give yourself a credit as you have made an extraordinary choice(at least , in the eyes of some) in an extraordinary time of history . And it certainly requires audacity.
    (2) Once you have made that choice , do not second guess yourself despite what people said .
    (3) And as I wrote before : Sh*t happens everyday but the new world can still be brave.

    Salute

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  • That type of working day is not for me especially if inadequately funded. Agree with the above , as long as we accept the barage of work, General Practice will not be acceptable to the majority of us. This is why we are in the mess we are in.

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  • I don't think that schedule is going to be sustainable in the long term.....next stop; Burnout City

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  • Dr Gund

    Bravo! A shining example. 'Audacity of hope'. 🎩s off to you ...a true warrior !

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  • Have you lost your passport? Always keen to help colleagues... https://www.gov.uk/government/organisations/hm-passport-office 😀

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  • Can someone please tell me is this genuine or satire? Hard to tell these days.

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  • doctordog.

    Can't see you lasting long with that work schedule.
    Or is someone taking the mick dumping work on the 'junior ' partner?

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  • You have the Messiah complex and you may just make it!

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  • I am a partner and tend to arrive at work at 8.30 and leave at 6.30. There are probably 2 days a month when i feel rushed for lunch and 2 days a month when workload snowballs and I finish at 7. I never finish after 7.15, that is when the cleaners lock up. One day a week we have lunch during the practice meeting - that day is busy. We give ourselves a good number of leave days and generous terms with sickness and maternity. We do work hard during the day, but the day is rarely extended as a result.

    We do well financially - much better than I could do as a salaried doctor or even a locum. Therefore my shorter workday is not a reflection of a surgery that does not prioritise financial outcomes.

    We do have lots of things in our favour with our surgery. Nice area, cooperative patients and a dispensary, but we are not the only practice with that combination.

    Don't let the workload in this article, or the general moaners, discourage you from finding out what being a partner is like. I love it and am still making a very successful career from it. The opportunities are out there, it might take some work to find the right place.

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  • Good on you Phil.

    Yes I agree being a GP principal/partner is hard work but the job has its rewards. Up to people to look for what works for them.

    I have been a principal for 16 years. I have had ups and downs but I am glad I chose this as a vocation.

    Shame about so many negative comments from anonymous users. I am sorry they are feeling miserable and bitter but it isn't fair to take it out on you.

    Good luck with being a GP Trainer. New doctors need people like you to inspire them into the vocation!

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  • Secure environments GP

    I've been a GP Partner twice, and never again thank you.

    Of course, for some lucky ones it works, depends where you work as so many different practices out there with different management styles and financial risks.

    The uncapped workload, unsustainable demands, general lack of respect and financial pressures are just not worth it. I have a life to live and a family to be with. Instead of working 12+ hour days, I want to see my twins grow up and have physical & emotional energy left for the family after a day's work.

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