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Pulse's GP workload survey is open - take part now

Pulse is asking every GP to take our survey on your workload from Monday 11 February. Here we reported the workload pressures faced by GPs throughout the day

Take the survey now 

18:00: Pulse is about to open its GP workload survey - please take part by sending us all the details from your day.

Thanks to all the GPs who sent in comments below - as well as to those who sent us anecdotes that we couldn't fit in. 

17:30: Dr David Turner reflects on how his day was looking at around 4:15 today - and says he's expecting to still be in his practice come 7pm tonight:

'18 patients and two phone consultations in morning clinic. Six patients seen on home visit to retirement complex. Practice meeting for one hour. Prescriptions/paperwork/letters taking up approximately an hour.  Phone call to coroner concerning sudden death.

'12 patients booked in so far for afternoon clinic - and I will review all patients seen by our medical student.

Arrived this morning at 8.30am and expect to leave 7pm - watch this space!'

 

17:00: It's been a full day of locum GP work for Dr Zoe Norris - one of our Pulse columnists - who tells us she's had back-to-back appointments, followed by home visits involving complex patients:

'Full day of locum work for me today. Back-to-back appointments, running late as always throughout the morning.

'Straight into home visits  - each took 35 minutes, with complex patients and for which I didn’t have time to type up before afternoon surgery started (first patient already waiting when I got back!)

'No lunch as usual - pinched a shortbread biscuit from reception. Afternoon surgery accompanied by the practice's new registrar - didn’t get all my paperwork done because I was late leaving to collect the kids who were the last ones waiting at pick-up - again. I’m back at the surgery tomorrow so it will be an (unpaid) early start to finish off today’s work.'

16:40: Dr Nicholas Swale, a GP in Wiltshire, has told us he is is finding it 'impossible' to work with the amount of IT failures he is dealing with in practice today:

'Impossible to work at this intensity with a computer system that doesn't work properly. Noone seems to be interested in helping to improve this.

'My computer has to be restarted six to seven times a day, every day, just to stop it crashing - been like this for over six months - and my colleagues are having the same problem. This causes data safety issues, time issues, hassle.'

 

16:10: Dr Kieran Sharrock, based in Lincolnshire, reports he is glad not to be the duty doctor on shift today, based on his colleague's experience of over 100 patient contacts

15:55:  As demand for GPs grows and the recruitment crisis worsens, GPs increasingly face reports in the wider media that paint a picture of poor access and care for patients.

In Scotland, a news report from Edinburgh Evening News today states a 'GP recruitment crisis has created a postcode lottery of care for patients across the Lothians'.

The story points to an NHS survey, which found up to two thirds of patients at some of the 20 surgeries in the region 'feel they cannot contact their GP in the way they want'.

 

15:45:  In contrast to many of the GPs that have been in touch today, locum GP Dr John Stocker has told us he has in fact had a good morning in practice: 'All 15 patients turned up on time. No DNAs.'

However, he notes: 'No nurse practitioners here so a good mix of serious (patient with terminal lung cancer just starting to go down hill) to a child with a rash but otherwise well.

'As GPs, we need a mix to keep us sane. If every patient in every consultation is a serious and difficult case, this way lies stress, loss of enjoyment and burn out.

'It also helps to have personal lists so the patients are able to enjoy continuity, also helping the GP to save time and allow a relationship with the patient. Patients are also more likely to wait a week or two to see their own GP rather than wait two weeks only to get the next "cab in the rank".

'In my opinion, after 40 years qualified and 35 as a GP (currently a long term maternity locum) almost all "progress" has made things worse for the GP.'

 

15:30:  The pressures facing general practice are affecting all staff - leading to this practice manager posting on Twitter today about their decision to leave their job, in an attempt to find a better work-life balance

15:20: Eight GP practices in Buckinghamshire have been forced to stop providing non-core services, due to growing workload.

Writing to Berkshire, Buckinghamshire and Oxfordshire LMCs last December, the practices announced their decision to cease the provision of seven different non-core services by August this year at the latest, including ear syringing, 24-hour blood pressure monitoring, spirometry for diagnosis, ECGs, ring pessary, PSA monitoring and MGUS monitoring.

The LMCs supports the decision, arguing that in light of growing practice workload, which is not accompanied by a corresponding increase in resources, ‘practices are quite right to prioritise their essential core services over non-contractual unfunded services’.

15:00: Updates from twitter:

14:15:  The introduction of new digital technology – such as artificial intelligence – will free up GPs to spend more time with patients, according to a new report from Health Education England.

The review on the digital future of the NHS, looking at the implementation and impact of digital healthcare technologies, said technological innovation ‘will not replace healthcare professionals, but will enhance them’, thereby giving GPs ‘more time to care for patients’.

Adoption of new technologies will ‘enable staff to gain more time to care, promoting deeper interaction with patients’. Clinicians will benefit from ‘smarter triage’, which will reduce the volume of clinical workload and ‘free up time for patients with the greatest and most immediate need’, the report said.

13:50 An interesting discussion on Twitter, following Dr Nicholas Grundy's tweet on problems with internet speeds. With a health secretary who is famously pro-tech, some GPs are saying we should be focusing on getting the basics right first:

13:45: GP updates:

13:35:  Copperfield writes:'Well bloody typically it's been a breeze this morning with only 17 patients and two phonecalls, though those patients involved 35 separate problems at a cool 5.14 mins per problem if you do the math. Also 2 meetings, one troubleshoot, loads of repeat scripts, 5 lab reports, 4 letters and much less coffee than I feel I need.

'The real action has been over on day duty where the poor girl has dealt with 15 triage calls, 12 appts and 5 visit requests plus God knows what else. I'd ask her to complete the workload survey at the end of the day if it were not for the fact that I value my testicles.'

13:00: Practice manager Louise Pilcher writes:'Our GPs are hard working but cannot keep up with the demand on their day. I have had to set some strict times on their working day, as it is now not proving safe practice if they work overtime. 

'They are expected to change their referral patterns to suit ever decreasing local and specialist services. Patients are more demanding as they feel they should be seen and sorted out almost immediately. 

'My current working day is from 6am to 6:30pm to ensure all my staff are helped and supported as the sheer volume of work has increased. Disappointing now we have an expected workload and opening hours of 8 to 8 every day.

'In our local area we have gone from 19 to 14 practices and are unable to temporarily close our registration, so on average you have practices in our area with 3,300 patients per GP. But my sole trader GP here is left responsible for 10,500 patients.'

12:50:  Winchester GP partner Dr Helen Lambert writes: 'A busy Monday morning, compounded by one GP, one advanced nurse practitioner and one practice nurse off sick. Normally we can cope well and have made proactive steps to manage sickness but this is unprecedented and unpredictable.

'We need a "black alert" facility like secondary care have - sometimes when demand is high, compounded by reduced staffing and everyone working at full capacity it just isn’t safe. Where’s our emergency stop button?'

12:40 Dr Nicholas Grundy, chair of campaign group GP Survival, points out other problems heaping workload on GPs:

12:10: Updates from one GP:

12:00: Dorset GP partner of a 7,000+ practice writes: 'Recent senior partner retired, no applicants. Another partner relocated and has become a locum. Nurse practitioner is off sick. Emergency Care Practitioner left for personal reasons, last week. Recruitment is impossible. It’s just locum cover, plus me today. No-one else to do any of the day paperwork, but me. Fed up.'

11:50: Family Doctor Association chair Dr Peter Swinyard writes: 'Just finished the face to faces – now for a couple of phone requests for fit notes and a pile of script queries. 12 patients, 2 non attenders, 2 knees injected, 2 phone consultations, 4 interruptions by nurses for advice and script signing, a couple of urgent emails to respond to. 8 complex prescription queries, a stack of CD prescriptions to sign by hand and 35 EPS prescriptions to authorise. All part of the fun of the day.'

11:30: RCGP chair Professor Helen Stokes-Lampard said: 'Morning surgery is now coming to a close and I’ve reviewed 47 sets of notes and done six patient phone consultations, including one that necessitated an urgent referral to the nearby ENT unit.

'After seven minutes of waiting to get through, a very professional SHO came to the phone and managed to fit my patient in tomorrow – a great result for every at our end.

'However, it took a total of 28 minutes of clinical time to sort, plus two GPs, two receptionists, a minor injuries unit, and a mound of patient stress. It also turned out that the case was originally an out-of-hours situation, so could have been dealt with last night if our colleagues had had the right technology available. I’m now off to a meeting to allocate home visits for the day, and catch up on clinical challenges with the team.'

11:15 Some updates from one GP on their workload:

10:45 We are aware of the irony of adding to your workload by asking you to complete a workload survey! Something that Through the K Hole captures perfectly.

However, we do hope that - by filling in the survey - it will give us what we need to reduce workload. You can see our reasoning here.

10:30 We have an email from a Dr Aaliya Aziz. She points out that secondary care is still dumping workload on GPs, despite a pledge to prevent this.

She writes: ’Despite the new (and very clear) hospital contract, we still get letters requesting medication prescription and also follow up regarding tests organised by the hospital! Due to the delay in receiving hospital letters you then face a situation where, in the patients’ best interest, issuing a prescription is probably the best outcome— as opposed to writing back, waiting for them to respond and then the patient getting a px a month too late, when they should have in fact got it whilst they had the first appointment. Therefore, as GPs we are faced with a delicate situation where if we did not issue the px it would probably result in a patient complaining.

’A very good example of this sort of complicated situation is as follows - a patient with suspected angina was seen by cardiology, had tests done which suggested cv disease and needed medication. The GP surgery received a letter almost 3-4 weeks later requesting the patient to go on beta blockers, aspirin and statin. As per the new contract the patient should have been counselled and medication commenced - it was not. The patient wanted his medication, was not happy to wait for cardiology response and threatened that should he have a heart attack it would be the GP’s fault. The patient was given an appointment at the GP surgery, counselled regarding the medication and commenced on it. Yet another example of the GP having to pick up dumped work from secondary care. This I am afraid is a daily occurrence!’

10:00 Unfortunately, not a week goes by without another story about potential increases in GP workload. On Thursday, we reported about more public health cuts in Walsall that will have the potential to massively increase GP workload.

This is one of the most drastic examples of cuts. But due to Government cuts, every English council is having to make cuts that could heap workload on GPs.

9:20 More GPs are giving us examples of their workload today. Dr Elizabeth Flett says she had 20 online consultations by 9am

9:00 We’ll kick off with RCGP chair Professor Helen Stokes-Lampard tweeting about her day in clinic: 

8:45  Welcome to the live blog for Pulse’s biggest ever survey on workload. This is the first time we have ever undertaken something like this, and we want as many GPs as possible to participate to provide policy-makers with hard evidence about what life is like on the coalface of general practice. We will be updating this live blog throughout the day.

If you want to know why we are taking this survey, please read our editor’s blog here.

We will be opening the survey at 6:30pm because we want you to tell us everything that has happened in your working day today either on social media, including #GPworkload, or by emailing us at workload@pulsetoday.co.uk

To make a note of all the patient contacts you have today - see here for more details on what we will be asking.

Come back to the Pulse website at 6:30pm for the survey link.

And for further reading on what we are doing, please see here:

Please contact workload@pulsetoday.co.uk to let us know how your day is going, or use #GPworkload on social media

Readers' comments (9)

  • I AM TOO BUSY SEEING PATIENTS TO GIVE A "RUNNING COMMENTARY" ON MY WORKLOAD....

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  • doctordog.

    But will anyone take any notice?

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  • HEE we need a reasonable internet speed first,it is terrible in the provinces.

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  • Took Early Retirement

    The chap with the IT problem needs to switch from Vision to System 1. For me that ran on rails.

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  • makes an interesting read so far.
    agree will anyone take notice?
    a great experiment though. lets see what the results show.

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  • Siraj Shah

    As a single handed GP with list size of 2800 patients my daily work starts at 6 AM from home having full remote access to clinical system using emisweb with integrated “babblevoice” telephone system.
    Today 11/2/2019 I have dealt with:

    27: Test results
    15: IC24/111 reports
    12: Email electronic discharge letters
    18: Telephone consultations
    25: Patient consultations
    02: Emergency appointments
    25: Hospital Clinic letters
    110: Repeat prescriptions
    01: Home visit
    Back home at 8 PM

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  • Stories of heroism. Sadly will all fall on deaf ears. Only copayments will limit workload. Political suicide for any government. The mistake was made in 1948 and there’s no going back.

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  • The workload survey does not give the opportunity to really reflect the GP day. A partners day is about so much more that direct patient contacts. There was no opportunity to tell you about the letters the meeting the electronic prescriptions the path results the supervision of the FY2 dr the patient related queries sent by task and the safe guarding, significant events complaints and terminal patients discussed. 20 patient contact on the surgpvey but an additional 130 (approx) patients were dealt with in some way by me yesterday. This is why is isn’t safe

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  • |What a con | GP Partner/Principal|11 Feb 2019 10:43pm

    Don't give up yet, the fight still goes on. The classic liberals are on the resurgence. The argument that increased individual responsibility benefits all, and that unnecessary state involvement harms all... That is how we can change direction.

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