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CAMHS won't see you now

Let’s stop fuelling the ‘magic time’ myth

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The biggest threat to UK general practice isn’t underfunding, poor recruitment, or the tendency some secondary care doctors have to treat us as their community-based house officers. The danger we face is proliferating constantly, and has seeped into every aspect of our working day: ‘magic time’.

Nowhere is this more apparent than in the Daily Mail’s recent sensationalist front-page story about GP opening hours.The Mail lambasted the 46% of surgeries that close during core hours, in terms which suggested that we all down tools every lunchtime for a siesta and close one afternoon a week for a few rounds of golf. The most juicy aspect of the report – the fact that the Commons Public Accounts Committee (PAC) said that the Government’s promised seven-day access may, at great expense, simply duplicate existing out-of-hours GP provision – was buried halfway down the page.

The Mail describes surgeries that close in this way as ‘failing’ their patients. Underneath the emotive language, the paper is describing an attitude which is becoming only too common in modern primary care: that the only work which counts is seeing patients.

The average Daily Mail reader would, no doubt, be incensed if they requested a repeat prescription and it could not be issued because their doctor was so busy consulting that he did not have time to reauthorise the script. Even the erstwhile members of the PAC might raise an eyebrow if they rang their own surgery to ask about their blood results, and were told, in perpetuity, that the GP had not had time to look at them yet because she was seeing patients.

Practices that close during core hours do so for all kinds of reasons, and the PAC report acknowledges that workforce shortages mean that there are not enough GPs to meet demand. NHS England told the Committee that the main reason for GPs leaving the profession is workload. Yet the Daily Mail’s stance seems to be that GPs should not have any allocated time in which to complete the large chunk of their workload which is not direct patient contact.

Every GP knows that blood results, prescription reauthorisations, and hospital letters can add hours to the working day, and that’s before considering non-NHS work like insurance reports and medicals. Such work forms a vital facet of patient care, and we need time in which to do it. If some surgeries have found that the best way to create that time is to close the front doors for a few hours a week, and they are able to do this and still meet their patients’ needs, then why not? Do the members of the PAC feel they know more about how to deliver patient care than GPs who work on the frontline day in, day out? If surgeries are no longer allowed the freedom to manage their (considerable, and growing) workload as they see fit, then when will non-patient-facing work get done? Does the Daily Mail think that we can conjure extra hours into our working day – or, more likely, do they simply not care if GPs have to stay in the surgery for many hours after the doors have shut every night?

The Mail would have you believe that there is a great tidal wave of unmet need which is crashing against closed surgery doors while GPs are off playing golf. Unsurprisingly, the evidence does not back this up. A pilot of GP extended hours in Manchester  demonstrated little impact on walk-in centre or out-of-hours GP attendances, suggesting that increasing access might have increased demand. This reinforces what most GPs know to be true: that the easier you make it for patients to see you, the more likely they are to consult you with a cough they’ve had for six hours, or because they want ‘a letter for the housing’ saying their council flat is haunted.

The proposed new GP trainee work schedule is a perfect example of ‘magic time’. In order to comply with the new junior doctors’ contract and work no more than 40 hours per week on average, NHS Employers have produced a document suggesting that GP trainees should be spending up to six hours a day offering face-to-face appointments while managing to fit their admin into an unfeasibly short window. For example, on Fridays the model timetable suggests that trainees should have an hour set aside for ‘admin/visits’. There are plenty of qualified GPs who would struggle to do their day’s admin in an hour, let alone squeezing in a home visit as well. In reality, trainees will learn to do as qualified GPs do – come in early, or stay late, or catch up with their admin on their half day – but the model timetable neatly demonstrates that the powers that be either do not know, or do not care, how hard GPs work, and that they do not value our non-clinical time.

Some GPs are guilty of propagating the myth of ‘magic time’. I am approaching the end of my training and have been looking for a job. Having read countless job adverts and visited many prospective surgeries – not to mention talking to friends about their workplaces – I have encountered more than one GP who nonchalantly boasts about being out of the door at 6.30pm sharp on a duty day, without acknowledging that they come in at 7am every morning to clear their admin. I don’t criticise them for that – the work exists and needs to be done. But I don’t think that playing down our workload, and pretending we have a better work-life balance than we do, will do GPs any favours.

I think it’s time for a bit more honesty – from GPs, from those who contract with us, and from the public – about the work that we do. Only then will we stand a chance of being funded and resourced appropriately.

Dr Heather Ryan is a GP registrar in Liverpool. You can follow her on Twitter @DrHFRyan and view any conflicts of interest here.

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Readers' comments (11)

  • Vinci Ho

    Paying more attention to the bullies is feeding the bullies......

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  • The policy of removing the hospital follow up, especially after a complex admission and rapid discharge, means that the GP magic time is particularly important given all the dangers lurking in the typed discharge letters e.g dodgy bloods or chest X-rays for GP to follow up yet patient has NO IDEA they need this doing. Even if I bounce such requests back I still need to see them buried on page 4.

    I suppose MPs are only working when in the chamber and footballers only work 90 mins a week.

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  • AlanAlmond

    Phone calls exist in magic time don't they. Used to be you did a morning seeing patients then wierdly a few years ago it started to become the norm that a bunch of 'urgent' phone calls get tagged on at the end...then that morphed into 5 ...then they're more added magically between patients during the morning..all to be done in non existent 'magic time' despite actually take real time to complete. When you get sued no one wil ask wether the consult took place in real time or magic time...they only care that you screwed up.

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  • Here's and idea:
    Lets only issue repeat presriptions, read and action letters/discharge notes or review test results with the patient in front of us. This would satisfy the Daily Fail's agenda.
    How quickly would this bring the NHS to its kness....

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  • I was on call today for the practice. This hellish day comes round once a fortnight as i am half time. From 8am to 7pm I did not stop. I had nothing to drink,just as well as I did not get to wee again until i got home. I had no lunch.

    I just made decision after decision. When I finished my letters and results and came back from my visits it was time for afternoon surgery, which i made with 1 minute to spare. I had two hours to see 12 patients but i also had 9 'queries' to deal with, all in that 'magical time'. In reality I shortchanged the actual patients i saw. They got even less than ten minutes. Still I overran and i will be coming in on my day off to tie up all the loose ends. I can do that because I am part time. The full timers have no free days to mop up the over runs. 7 day general practice will kill it and us and probably some of our patients.

    My morning was even more hellish, 20 patients to see and 11 queries. It cannot go on. I have made plans to leave General Practice in the next 18 months when I will be 55. I am leaving as soon as I have enough to live on. It will not be a lavish retirement but it will be heavenly compared to the hell that is current General Practice.

    Looking back on my 30 year career, I am sad. I can honestly say that the NHS exploited me most of that time. I can look fondly on my patients and the illnesses i diagnosed, but I am bitter at what the NHS does to its' doctors. We are treated as machines and have to suppress our human needs.

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  • Maverick

    To faithful hound. Splendid decision. I can reassure you that life away from General Practice is wonderful.
    To any other GPs out there who are wondering if they should jump, the answer is absolutely overwhelmingly YES.
    Abandon ship. NHSE/CQC/CCG/LMC/government etc are not listening and don't care. If you've had enough and can afford to leave then don't hesitate. I left nearly a year ago aged 56 and life is just tremendous. I'm actually better off on my pension than when I was working. Lower tax bills, no indemnity fees. Life is stress free.
    Just do it.....
    Good luck.

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  • Good article.....110% agree

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  • I seem to remember, and it is a long time ago so I could be mistaken, that the old red book (GP contract) stipulated that a full time GP had to show that they were open for direct patient contact (including visits) for 20 hours a week.

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  • What is the point of an article like this on pulsetoday? We know the DM manipulates it readers. Why aren't articles like this being posted and shared in the public domain instead of preaching to the converted. I am livid with what has happened to our profession.

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  • Faithful Hound.

    I wish you all the best. You cannot conceive how wonderful retirement is until you have done it.

    Well done.

    What worries me is that I have been retired for 6yrs now and the job nearly killed me. I know that it is much worse so how is anyone carrying on!

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