24 hours in general practice: the day in full
Pulse’s special project offers a unique portrait of modern British general practice in just one day, through the voice of our readers
23.01 It’s not quite been 24 hours, but we’re about to wrap up the live blog for the evening. A massive thanks to the dozens of GPs who’ve taken part in an extraordinary day, either by emailing in submissions or on Twitter, where the hashtag #24hoursinGP has attracted almost 800 tweets and counting. If we haven’t managed to include your submission so far, we will looking at everything we’ve had in and adding to this blog tomorrow, and edited highlights of the final version will appear in the May issue of Pulse.
General practice, of course, will be continuing overnight, with dedicated GPs across the country responding to out-of-hours calls to ensure a truly 24/7 service. We’ll leave you with this tweet from Dr Susan Bowie up in the Shetlands - proof that a very traditional model of general practice is still alive and kicking.
— Susan Bowie (@docsuzy) April 1, 2014
Thanks for reading.
20.51 For Dr Thomas Gillham, a 12-hour day at his Hertfordshire practice has finally drawn to a close.
We’ve handed over to the local out-of-hours team to see us through til morning. 24 hours in GP, a profession that never sleeps and barely rests. And I thought we were all supposed to be on the golf course?
Read his full post here: The profession that never sleeps
20.47 Dr Catherine Beanland, a GP in Shropshire, shows off one of the compensations of rural practice.
— DrCatherineBeanland (@DrBeanland) April 1, 2014
20.45 GP payment problems and problematic NHS IT projects have been much in the news lately, and a combination of the two have dragged practice QOF lead Dr Clare Dyer into the surgery on what was supposed to be her day off. She writes:
I am in work because I don’t trust the system and its methods of payment, so I am making hard copies from our IT system of all the QOF points we have achieved.
Read her full post here:Wrestling with IT
19.24 Today is, of course, April Fool’s Day, and for all the hard work today, general practice hasn’t escaped the odd prank either.
A few ‘Mr Ivor biguns’ and ‘Mr G Raffs’ thrown in the 1st April mix by receptionists to keep me on my toes today #24hoursinGP
— Paul (@drfez83) April 1, 2014
19.01 Pulse’s star columnist Copperfield has chipped in with a pre-written summary of a day like any other. Read his full post here: Woulda coulda shoulda
18.35 New NHS England chief executive Simon Stevens’ maiden speech is over - and the verdict is in from practice managing director Gloria Middleton, sitting in the audience in Newcastle.
The room was full of professionals and when the new NHS England chief exec spoke you could have heard a pin drop. I purposely did not Google him beforehand as wanted to keep an open mind.
It was a good start. He has worked in the North East so knows the area. He is certainly a man who knows what he wants, when and how. If I had to sum up the vision in one word it would be ‘integration’.
18.11 Dr Krishna Kasaraneni, chair of the BMA’s Equality and Diversity Committee and the GP Trainees’ Subcommittee, is done for the day - at the surgery at least.
— Krishna Kasaraneni (@Dr_Kasaraneni) April 1, 2014
18.01 Interestingly, for a project on general practice timed to coincide with the first anniversary of the NHS reforms, commissioning hasn’t featured heavily today. But practice funding issues and in particular payment problems certainly have.
Alison Dalal, practice manager at the Paddington Green Health Centre in central London, is ending her day mapping LESs and DESs and trying to work out why her practice’s out-of-hours payments have been reduced. Read her full post here: Getting to grips with the new GP contract
17.47 A quick word about how this live-blog will work for the rest of the evening. We’re still getting lots of submissions coming in, and we will try and post as many as possible - even if your submission doesn’t go up immediately, an edited version of ‘24 hours in general practice’ is going to appear in the next issue of Pulse magazine, so it may be added in due course.
We will be here well into the evening though, and will be looking for a couple of really strong posts to round the day off. So if you’d like to share how your day’s gone or offer a wider reflection on the contributions we’ve had so far, please email Pulse editor firstname.lastname@example.org.
17.38 No doubt that general practice can be an exhausting, draining, horrendously difficult job - but it does have its compensations too.
— Adnan R.Siddiqui (@AdnanRSiddiqui0) April 1, 2014
17.23 Here’s a complaint you hear frequently from GPs (and voiced on this occasion by Dr Eithne MacRae, GP in St Helens):
Can do without all the NHS 111 reports. Why do they all start off with a page of what the patient does not have? Why does nearly every report demand action from the GP within two hours or an immediate ambulance – which, funnily enough, the patients refuse?
16.51 Away from ‘24 hours in general practice’, the big NHS news this afternoon will be the new chief executive of NHS England, Simon Stevens, giving his first public address.
Gloria Middleton, managing director of the Westbourne Medical Group in Houghton-le-Spring, Tyne and Wear, will be in the audience, after a busy day which has included checking year-end QOF figures and proof reading a proposal for a new project for people with learning disabilites in Sunderland. She writes:
En route to Newcastle Centre for Life. I’m being open minded! Arrived early as can’t judge traffic so will read the armed forces paper I’ve just been sent before making a move.
Check back to hear what she makes of Mr Stevens’ first speech shortly. It’s due to get underway just after 5pm.
16.35 All around the country, GPs are now beginning late afternoon surgeries. Dr Caroline Yorston, a GP at the Didcot Health Centre in Oxfordshire, has all the key equipment ready.
— CarolineYorston (@CarolineYorston) April 1, 2014
16.15 Up in the Shetland Islands, Dr Susan Bowie is preparing for the next influx of patients.
Ready for the evening surgery. Surgery garden and car park ‘redd up’ revealed a full black bag of tins and bottles - and a very old £10 note stuck in a crisp packet.
Before you Google ‘redd up’, we’ve saved you the hassle…
— Simon Ruffle (@nhsfatcat) April 1, 2014
15.36 Derbyshire GP Dr Anne Tompkinson - who you may remember didn’t get much sleep last night and had a busy start to the day dealing with her children - is now heading home after her half-day session.
I will reflect on cases as I drive home. I enjoyed the consultations, some patients I haven’t met before, and some I have seen previously. Probably 50% of the time spent was in communication with patients and the rest of the time covering the other aspects of the work. Probably mirrors my experience as a mother - so much goes on behind the scenes!
Read her full post here: Heading home at last
15.21 Dr Jonathan Harte, at the Aspley Medical Centrein Nottingham, checks in:
Back from visits, grab a coffee and do another batch of repeat prescription requests. Luckily no further phone messages, so write up visit and make referral to district nurse before carrying on with referrals and paperwork generated from this week’s consultations. Later afternoon surgery starts at 3.30pm and I’m duty doc, so you never know what will need doing.
15.17 Why did we call it ‘24 hours in general practice’? Well, there’s a fairly obvious parallel with a certain documentary programme, for one - but Telford GP Dr Adam Pringle has another take on it.
Twenty-four hours in general practice - soon to be a fairly typical working today if the workload continues to rise. Although at least one of those hours will as usual be spent considering which of the three realistic options to choose - retire, locum, or emigrate?
15.15 And right on cue, here’s another from two senior GPs (although it was actually posted a few hours ago). Dr Kailash Chand, deputy chair of the BMA, and GPC member Dr Helena McKeown are in Westminster today for a seminar on the NHS’ future.
— Dr Kailash Chand OBE (@KailashChandOBE) April 1, 2014
15.11 Family Doctor Association chair and Swindon GP Dr Peter Swinyard has just modelled his new Bluetooth headset on Twitter. More #24hoursinGPselfies, please…
— Peter Swinyard (@phoenixdoc) April 1, 2014
15.10 Remember Dr Tom Gillham’s lunch-date with the accountant? Well, now you can find out how it went. Read the full post here: Reflecting on the State of our Finances
15.06 Is a strict ten-minute appointment target a necessity to manage demand in modern general practice, or does it encourage counter-productive clock-watching? After dealing with a mix of longer routine and shorter emergency appointments in her morning surgery, it’s a topicCroydon GP Dr Sadia Qureshi is keen to explore. Read her full post: How long should a GP appointment be? Well, it depends…
14.52 An early piece of feedback for health secretary Jeremy Hunt on the new contractual requirement for patients to be given a ‘named GP’, from St Helens GP Dr Eithne MacRae.
Can so do without telling those over-75 who their registered GP is – eats into the consultation.
14.47 Professor Clare Gerada, formerly RCGP chair and now chair of primary care transformation with NHS England’s London area team, has had a mixed morning working at a drug rehab session, moving between meetings and wresting with NHS.net. Read her full post here: From seeing patients to transforming primary care
14.31 ‘I hardly have time to write this because I’ve been so busy,’ begins Dr Susan Stuttard, who is spending the day locuming in Selby, north Yorkshire. She’s not exaggerating - morning surgery, extras, visits and then on call. Read her full post here: A locum’s lot
14.25 If you’re a practice manager, you have to be a jack of all trades. As this rather dramatic photo from Somerset practice manager Daniel Vincent goes to show.
— Daniel Vincent (@somersetpm) April 1, 2014
14.16 We’ve heard lots from grassroots GPs this morning, but what of the great and good of general practice? Within the hour, we’ll be hearing from former RCGP chair Professor Clare Gerada about her morning, but first up is GPC chair Dr Chaand Nagpaul.
‘I am in a taxi on my way to Parliament,’ he tells our reporter via mobile phone. Dr Nagpaul is due to give evidence this afternoon to an all party parliamentary group on winter pressures in the health service.
14.00 What did you have for lunch? Chances are it wasn’t as nice as what Dr Susan Bowie had, up in the Shetland Islands.
Busy complex morning. Supervising a lovely medical student too. She is surprised by the amount of pathology we see in GP, rarely a cough or cold. Finishing off letters and notes after a quick lunch. Great fish cakes followed by Peter Sinclair’s bannocks and homemade rhubarb jam.
You can find out more about Peter Sinclair’s Shetland bannocks here, FYI. And yes, there are pictures…
13.43 Southend is also beautiful and sunny today, Dr Krishna Chaturvedi reports - but staff absences have made for a busier-than-normal morning surgery. Respite is on the horizon though, in the shape of two learning events this afternoon. Read his full post:A jam-packed surgery in sunny Southend
13.20 A recurring theme we’re hearing from many GPs is just how difficult it can be to squeeze lunch into an, er, lunch break. Dr Jacqueline Marshall, from the Oxgate Gardens Surgery in Brent, north London, writes:
Just finished morning surgery. Visits now,then meeting with health visitor in between going through results, letters, e-mails, repeat scripts and then afternoon triage. Not sure where lunch fits in - maybe I’ll manage a sandwich on the way to the visit?
13.19 In High Wycombe, Dr Kristina King is fast coming to the conclusion that GPs cannot exist on biscuits alone. Read her full post here: Dying for lunch
13.17 Sally Dixon, practice manager at the Barnby Gate Surgery in Newark, says today only means one thing for practice managers. ‘It’s the first day of the new QOF year,’ she writes. ‘We’ll be looking at how we will keep our income stable for the next year.’
13.02 Dr Saj Azfar, a GP in Rochdale, offers an increasingly familiar story of juggling patients and paperwork, all the while with one eye on the clock. He writes:
Seen 18 patients this morning - done four phone consults, dealt with 18 lab reports and about a dozen electronic queries on medications, sick notes etc. Still got my letters to do but got to get to a meeting with our PPG at which I am presenting today. It all starts again at 3pm so the paperwork will just have to go home with me tonight I think…
13.00 Rheumatology GPSI Dr Louise Warburton holds a specialist clinic and then attends a meeting at her CCG
Because I have the time to sit down and explain everything to patients – I was able to come up with effective management plans for co-morbidities and complex problems. Today I was able to avoid requesting an MRI scan and wasting precious resources on patients simply because we had time to talk all the options through.
Read her full post here: Discussing how to get GPs on board with seven-day working
12.48 Another quick update from Dr Jonathan Harte in Nottingham.
The referrals dictated earlier are ready for checking and signing during lunch at my desk as usual. Then there’s more paperwork to be done - reauthorizing prescriptions, more call back requests, chasing hospital letters and test results. There do seem more and more requests for ‘GP to chase…’ following hospital admissions or outpatient tests. It’s easier than it was as we can access the hospital lab system online - though now we can, maybe that encourages junior docs to expect us to do the chasing.
12.24 Dr Louise Morrison, a GP ST3 working in Northern Ireland, reports that she has ‘grabbed a cuppa’ after a morning surgery which started at 9am, and is now struggling through a pile of referrals. One particular patient prompts her to consult somer rather unhelpful guidance. ‘Printed off the guidelines and realised I’ve wasted a lot of paper,’ she says ruefully.
12.00 Pulse blogger and Hertfordshire GP Dr Tom Gillham has a lunch date with the money men.
I find the financials taxing, if you’ll pardon the pun. No real training during the Registrar Years on this particular aspect of general practice. I’ve sat in meetings before with accountants and find their meat and drink particularly undigestible. I know what will happen. He’ll talk, we’ll nod…
Read his full post here: A buffet lunch with the accountant
— Krishna Kasaraneni (@Dr_Kasaraneni) April 1, 2014
— Peter Swinyard (@phoenixdoc) April 1, 2014
11.48 Nottingham GP Dr Jonathan Harte, back from his visit to the nursing home, celebrates the sheer variety of general practice. Read his full post here: Are GPs the last General Physicians?
11.30 Rowena Angell, a practice manager in Cornwall, has been celebrating a rare moment of feeling smug:
Flurry of e-mails from the practice manager group about dementia QOF returns, another of those not-quite-so-automatic data submissions. Conflicting advice abounds (only fill in the last box or put zero in all boxes but the last box, do nothing, do something) and I sit smugly on this one having done it last week (filled in all the boxes with actual numbers, made sense at the time) and asked a very patient person at the NHS England LAT to check it for me; I respond to the flurry with gusto, helpful or not.
11.22 In GP surgeries up and down the land, an important ritual is now underway.
Morning surgery over and all GPs gather for coffee, chat, and visit-sorting. This is a vital part of day for team-spirit. #24HoursinGP
— Andrew Green (@DrAndrewGreen) April 1, 2014
11.13 Dr Cat Harrison, a GP partner at the Tuxford Medical Centre in Newark who also moonlights as a volunteer triathlon coach, wasn’t sure she’d have time to contribute today. So emailed through yesterday evening to let us know what she would be doing (and it’s a contender for the most exhausting day we’ve heard of so far, quite literally…)
I’ve just got in from a 10-hour work day which was followed by a three-hour Safeguarding and Protecting Children workshop for my other ‘job’ as a volunteer triathlon coach. I’ll be up again at 5am to be at the leisure centre to coach a triathlon swim session at 6am. I’ll then swim myself for an hour from 7am to 8am before heading to work for another 10-hour day, before I finish at 6:30pm and join my ladies running group for an hour of hill sprints. No rest for the ‘wicked’ GP!
11.11 Practice manager Paul Conroy is still wading through paperwork at the Mersea Island Medical Practice on the Essex coast.
Some work on our GP trainee schedule and planning the rota. Also looking at plans for our GP returner joining us from 1 May. Down to 80ish emails, and cleared the post. I can soon get on with the claims work!
11.00 In Nottingham, Dr Jonathan Harte is preparing to head out to the local care home. Read his full post here: Wardroundatthenursinghome.
10.41 The sun is shining, the birds are singing and all is well in Cornwall, writes practice manager Rowena Angell. She’s had an exceptionally busy start to what will be a 12-hour day though, and with one GP off sick, the surgery will be stretched over the next few hours. Read her full post here: A practice manager swamped with paperwork
Just reviewed the date of an infant death so we can offer support to the family as the anniversary approaches. #24hoursinGP
— Maximillian Fandango (@Yelofnitram) April 1, 2014
— DrDean (@DeanEggitt) April 1, 2014
— Peter Swinyard (@phoenixdoc) April 1, 2014
10.18 At the Park Surgery in Heanor, Derbyshire, Dr Anne Tompkinson’s morning surgery is now well underway. She writes:
I have seen nine patients so far, all varied specialties. I have now hit a catch up slot. I’m spoit for choice really, I can check blood results for a patient, look at my letters on Docman, reauthorise a pile of repeat prescriptions or look at one of four telephone calls. What to do? And so I emailed Pulse.
By the way, my daughter’s tea date has confirmed. I think I’ll get back to the prescriptions…
10.13 Today marks exactly one year since CCGs first assumed control of NHS budgets - and so it’s a particularly important day for GP commissioners. Dr Stewart Findlay is chief clinical officer of Durham Dales, Easington and Sedgefield CCG, and is spending today getting to grips with the 2014/15 contracting round. Read his full post here: Overseeing a CCG budget of more than £400m
10.02 For Brent GP Dr Jacqueline Marshall, 1 April is a date when the QOF looms large. She writes:
Well I bet most of you did what I did first thing - look at QOF to see how many points you were awarded. There is a mixture of relief but also frustaration at how much work went into ticking so many boxes. How much does it really have to do with ‘quality’ and how much with Big Brother checking up on us?
So it’s on with the next year. Just when I had got rid of all those reminder boxes, up they pop again. It never ends.
10.00 Dr Sadia Qureshi, a salaried GP in Croydon, says she has already reassured a mum worried about their child and completed a short medical for a patient running a marathon this morning. She says:
Today I will be working with three different appointment times. I will first see 12 routine appointments of 10 minutes each. This will be followed with a 30 minute gap for telephone consultations and other admin queries. The afternoon surgery is for antenatal and postnatal appointments which will be 15 minutes each.
Later I will be reviewing the difference it makes to have those extra five minutes and commenting on the rushed emergency appointments.
09.59 Dr Kristina King is hitting the phones - but finds that none of the patients at her High Wycombe practice are seeing inappropriate advice. Read her full post here:Telephone triage
09.46 The ‘24 hours in general practice’ project is not only for GPs, it’s very much aimed at practice staff too - and for practice managers in particular 1 April is a busy day, with the start of a new financial year. Alison Dalal, a practice manager in central London, writes:
Spent yesterday submitting QOF evidence to NHS England by email and via CQRS, with my heart in my mouth – really concerned in case a tiny error means we won’t get paid for work we’ve actually done!
Anyway – deep breath and on to the start of the new financial year. Managed to grab a coffee and a bowl of Alpen before my first meeting of the day…
Read her full post here: A project with the patient participation group
09:20 Dr Eithne MacRae, a GP in Rainford, St Helens, is already making a start on getting to grips with the new ‘named GP’ responsibility in the GP contract in England from today. She writes:
Having to set up document during morning surgery as READ code not yet available for those over 75 whom I have told who their named GP is. All patients have to be informed before end of June and READ code only available in June so having to keep a separate record.
09.19 Paul Conroy, practice manager in West Mersea, Essex, has already racked up a number of administrative tasks. He writes:
Just finished our practice palliative care meeting, and rattled through a few computer issues with the office staff. Had a quick glance at the applications for our receptionist post we’re advertising, then I need to have a look at our LES claims and run the searches in EMIS to submit them all.
— Krishna Kasaraneni (@Dr_Kasaraneni) April 1, 2014
Tues is “academic” day - doing things related to doctorate & research/writing. Much needed after long day on Mondays incl DD! #24hoursinGP
— Richard Ma (@Richard_GP) April 1, 2014
Multiple problems in first few patients. Running behind already! #24hoursinGP
— Merlin Dunlop (@Crimpoffalength) April 1, 2014
09.01 Doing non-urgent home visits first thing can often be the best time for it, writes Dr Kristina King.
A lot of my non-urgent home visits are pre-8.30am, as it’s the best time to catch people in the correct attire, in bed and be able to arrange home blood tests, admissions etc before things get busier for us, the ambulances and secondary care. I hate sending people, and in particular the elderly, into hospital in the evenings, often very late as the ambulance times are longer then.
Read the full post here: A non-urgent home visit first thing
08:58 Sally Dixon, practice manager in Newark, Nottinghamshire, is looking at how her practice can improve their end-of-life care. She writes:
Planning how the practice will implement The Gold Standards Framework Primary Care Training Programme. This is all about improving the care for all people nearing the end of life.
08.45 Dr Susan Bowie is a GP in the far north of the UK, up in the Shetland Islands. After being on call overnight, she wakes up listening to the radio - and is sceptical of the lead health story.
Listening to Today programme. Seven fruit and veg a day? Is it an April fool? What’s the chances of that here.
08:39 Dr Eithne MacRae, a GP in Rainford, St Helens, is multi-tasking this morning. She writes:
Just time to add last night’s out-of-hours meeting on prostate cancer management into my appraisal before my first patient at 8.30am.
08.30 The first job for most GPs when they get to the surgery seems to be tackling a pile of admin, and that’s certainly the case for Nottingham GP Dr Jonathan Harte.
I boot up the PC and start on the electronic pathology results, checking and posting into the patient record. A small batch this time, only 23 patients-worth (but then I did do another 18 last night).
Read his full post here: Getting started on the electronic pathology results
— Mayur Lakhani (@DoctorMayur) April 1, 2014
08.21 Emails, childcare and a quick home visit - and that’s all before High Wycombe GP Dr Kristina King gets to the surgery. Read her full post: Up since 5am - thank God for remote working.
08.06 While pretty much every GP has a busy start to the day, spare a thought for the mums and dads out there for whom going to work is only half the challenge. Derbyshire GP Dr Anne Tompkinson was up in the night with her son and has her hands full getting the children ready first thing.
Read her full post here: A busy morning after a sleepless night
07.50 Dr Eurig Harries, a GP in New Quay, West Wales, has barely slept in anticipation of a life-changing day. He writes:
I start today in New Quay Surgery in Ceredigion. A new challenge halfway through my GP career. Awake at 1.53am in the morning. I can’t sleep as I’m half nervous, half excited. The last time I felt like this was 16 years ago when I started my first GP partnership at Meddygfa Rhiannon in Narberth, Pembrokeshire.
Read his full post here: A new challenge halfway through my GP career
07.46 Dr Farhana Lockhat, a GP in Nuneaton, Warwickshire, has a start to the day which is fairly typical of GPs who are also parents. She writes: ‘Just dropped daughter at bus stop and now getting to work. Start by looking through results and letters before surgery starts at 8.30 for three hours +/- extras.’
07.45 In the North West, a newly minted GP partner - one year today - enjoys a pleasant start to the day.
Tea and stories in bed with the kids. Perfect start to a rainy Stockport day #24hoursingp
— bec baldry (@bexlington) April 1, 2014
07.30 Many GPs heading in to their practices know that they will be facing a packed surgery this morning - but not Dr Peter Swinyard, a GP in Swindon and also chair of the Family Doctor Association. He writes:
As ever, with the Patient Access telephone triage system now in full swing, I start the day with a nearly empty diary. Looking down the lists before the phone starts ringing this morning, I have a couple of face-to-face consultations booked – one a follow up I booked in myself and the other a lady who accosted me in the car park last week and I asked to come in to see me.
Read his full post here: An empty diary.
07.15 GPs on Twitter are waking up - 7am to 8am is peak time for GPs to post on the social networking site - and are starting to add their own contributions using the hashtag #24hoursinGP.
Rushing through breakfast to get to work for 8….packed day ahead. #24hoursinGP
— Amy Small (@amyismall) April 1, 2014
— Dr Amir Hannan (@amirhannan) April 1, 2014
— Paul OG (@pogwolves) April 1, 2014
06.50 A short contribution from Dr Elliott Singer, a GP in Waltham Forest who will be blogging for us throughout the day. Dr Singer, who is also medical director of Londonwide LMCs, sets his alarm for 6.50am. Read his full post here: A short commute.
— Krishna Kasaraneni (@Dr_Kasaraneni) April 1, 2014
06.15 Dr Paul O’Grady, a salaried GP in Newcastle-upon-Tyne, gets the day underway with a look ahead to a busy morning at the surgery. ‘The first hour will be spent going through hospital letters, discharge summaries, pathology results and tasks and requests from our admin team,’ he writes. Read his full post here: A busy morning ahead.