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At the heart of general practice since 1960

Looks like we’re going off the rails

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The British railway network functions very well indeed, in certain circumstances. These circumstances include no maintenance work being done anywhere on any line, perfect weather conditions, full staff presence, no industrial action and every piece of computer being software in full and harmonious sympathy with every piece of computer hardware.

Of course this has never happened. There’s always a badger with the vapours near Acton, or a box of Kleenex lying dangerously on the line at Berwick. In short; there’s no slack in the system. And this is the point at which we have pretty much arrived in general practice.

Normal days are do-able. I and all my colleagues are in, the phones work, there’s no media-fuelled health hysteria, the local hospital can probably find a bed if push comes to shove, and the number of tediously self-centred narcissists clustering round our front door is smaller than the number of surreptitious smokers.

But I can’t remember the last day like that.

Someone is always on leave, or on a course. Someone else is enjoying a half-day of ‘personal development’. Someone else has buggered off to Australia (I can’t blame them) and has yet to be replaced. The registrar is with the trainer, earnestly watching videos of long-forgotten consultations. And the whole practice is still recovering from the mandatory half-day of city-wide learning showing us how to maximise our exposure to our patients. During which we lost 110 appointment slots.

And somehow, on a Friday afternoon with norovirus in the air, a practice that employs seven doctors only has two on duty, and one of them is me.

The computer screen is a malevolent instrument of torture. At 1.30pm the list of ‘urgent extra’ appointments becomes available, and I watch them fill up in 40 seconds or so. Then they’re added into fictional time slots. The ‘tasks’ list holds five ‘urgent’ and 32 ‘non-urgent’ claims on my attention. ‘The ‘even-more-urgent’ tasks alert, which deems itself more important than anything I am doing, is flashing on and off like a strobe light. People are knocking at the door: ‘Excuse me for interrupting…’ ‘Could you look at this ulcer…’ ‘Please sign this…’ ‘This sick note is urgent or they get no money…’

Unfortunately when my patience cracks and I bellow ‘WHAT NOW?’ at the next person to interrupt, she spills my cup of coffee all over herself. ‘Sorry, sorry,’ I chunter. ‘Oh and there’s this home visit request as well,’ she says, brushing Nescafé onto the carpet. ‘Constipated for a week.’ The room acquires a red tinge and time slows down.

Some time later, the building is empty and locked apart from me and my final ‘urgent extra’. ‘It’s these tits,’ she confides. ‘They’re not big enough. I’ve been meaning to come for a while. My friend is getting hers done on the NHS. She said you would write me a letter too.’

‘She was wrong,’ I say, rolling down the shutters. ‘But look at them!’ ‘No.’ ‘But my friend said…’ she protests as I gently prod her out of the room with my medical bag.

‘She was wrong, she was wrong.’

 Dr Phil Peverley is a GP in Sunderland

 

 

Readers' comments (9)

  • The home visit demand with the threat of a complaint if one does not visit, is a big problem. We have got to this stage because of the slack in us. We have to say no as a group. we are divided and there lies the problem......

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  • When you can no longer get through the visits in time for afternoon surgery you have a problem, similarly results and faxes not being dealt with till the next day because there was not a minute to spare to look at them.

    General Practice is becoming a dangerous place to work in.

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  • Una Coales

    Work to rule Pev.

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  • GP training is in a mess. it does not prepare you for this workload. wasting your time typing entries on eportfolio will not prepare you for this. when will we wake up

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  • I'm one of the one's who's 'buggered off to Australia'. Home visits are now entirely voluntary (and quite infrequent), appointments are 15 minutes - less patients= less burnout, and I've doubled my income. More respect from patients and more self-respect. If you don't mind working outside of the cities, Aus could be a great move.

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  • Home visits have become a bit of an elephant in the room for general practice. Whilst it's often nice to get out of the office (one of the great parts of the job, in fact), travelling to and from patients is an enormous drain on resources particularly when visits are demanded in late afternoons. The opportunity cost of being stuck in traffic is huge, during which time many more patients could have been assessed and managed. It is also costing us a lot in petrol and wear on cars which is never fully reimbursed. The demand is likely to go through the roof soon with demographic changes so the only option will be to outsource it to separate GP teams or more likely other practitioners such as paramedics and nurse practitioners.

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  • Perfect description. Were you a fly on my consulting room wall these last few years? My solution - jack in the partnership as soon as you're financially able and start to locum. Pick up other medical work - there are alternative careers out there if you can think outside the box. I know because I did it at the age of 51 just two short months ago. 24 years as a partner has made me reasonably marketable to other practices. The result - self-control and job satisfaction again.

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  • There is no one who writes quite like Phil !! Fab.

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  • Only managed one home visit in my 2 years working abroad, as they came with an additional charge, and everyone made it to the surgery.

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