Workload survey live blog: ‘This workload feels unmanageable’

Our survey has now launched – you can take it here

5:35pm: And that’s all from us today – many thanks from the Pulse team to all the GPs who’ve contributed to this live blog. We know that there will be many more who were so busy they weren’t able to contribute this time.

A reminder that we encourage all GPs to take part in our new survey to highlight your workload levels, so we can help to show that practices have been open during the pandemic.

Thank you again.

5:30pm: Dr Shaba Nabi will still be consulting with the final patients for a while yet, and that’s before starting on any clinical admin. But, she wants to make it home before her children’s bathtime.

5:25pm: The evening is underway, but Dudley GP still has six more patients to see, and four more to speak to. Fortunately, she’s feeling ‘a bit calmer’ now the end of the day is in sight.

However, two of her colleagues now have to tackle extended hours, and another half a surgery of patients is due to start again at 6.30pm. She asks: ‘How safe is that after a 12-hour day? But the income pays for a member of staff, so do it we must.’

5:23pm: Dr Prakash Kachhala gets back in touch over social media with this update on urgent care:

5:15pm: Dr Shaba Nabi talks us through how her afternoon progressed. After a half hour sandwich stop with colleagues at 1.30pm, she started a joint surgery with her GP trainee, which included listening to her consulting on the phone and debriefing about the morning’s patients.

She noted some interesting discussions about the role of a GP, such as where it starts and ends, and to try and learn about the Greek philosophy of stoicism and how it may help us to understand patients and their journeys.

Come 3.30pm, they jointly saw a patient who had a prolonged cough but two negative Covid tests.

At 4pm, she started listening to trainee recordings, to see what’s suitable for the RCA exam. It’s ‘very unrealistic having to tick all the boxes in ten minutes. When will we change this unrealistic expectation?’ asks Dr Nabi.

5pm: A stark sentiment to start to conclude this workload live blog with – the Dudley GP tells us: ‘I’ve been a GP for more than 20 years. I know about working hard. But this feels unmanageable.’

4:55pm: Hertfordshire GP Dr Sara Thompson has used our #GPworkload hashtag, also taking to Twitter to share some snippets of her working day. You can read this here:

4:50pm: As the day draws to a close (for us, at least…), we hear again from Dr Lisa Finnikin.

She started the afternoon’s clinic at 2.30pm, which meant 15 more contacts. She’d worked through lunch without a break to get through some of the tasks, including blood results and prescription requests.

In some contrast to the good news from elsewhere in the West Midands that we shared earlier on negative Covid tests, Dr Finnkin is still coming across lots of people every day with Covid symptoms, who haven’t considered it as a possibility nor arranged testing.

More broadly, she feels there’s a trend towards people coming forward with symptoms that they’ve had throughout lockdown, as they ‘cannot hang on any longer’ – leading to complex consultations and requiring face-to-face examinations.

Like other GPs we’ve spoken to today, she’s been seeing lots of mental health issues.

4:45pm: Let’s see how Dr David Mummery is getting on in the Hot Clinic. Turns out he’s still there, having just seen a child with a temperature and runny nose.

After this, he had a brief pause to go through the Docman letters, from which a lot of the specialist ones are asking the GPs to organise and follow up on a variety of scans. A typical example from neurosurgery might be: ‘GP to organise thoracic MRI scan’, with other tests that ‘in days gone by, secondary care would organise and review’.

This leads Dr Mummery to ponder whether GPs are turning into ‘community house officers’ for hospital trusts, and whether this model and transfer of care and risk continues with the evolving ICS.

4:40pm: The GP of Dudley managed to eat an apple whilst standing up doing today’s scanned letters, most of which are ‘densely packed’ about issues such as cancer treatment, ambulance call-outs and emergency admission or discharge – it’s unclear whether action is required or not.

Next, she goes through today’s blood results, and some things need action today, such as a new case of unexplained anaemia.

More happily, it’s the first day for months that all the Covid tests come back negative!

But it’s back to reality before long – an hour and a half in, and she’s still only four calls down, with near-constant interruptions from staff about various issues.

A little later, she had to refer a patient back to the same specialist for the third time, because they would only deal with one symptom per appointment, even though the symptoms are linked. She comments: ‘I don’t know why’.

4:30pm: Fittingly, Dr Dave Triska’s Surrey practice has just hit its busiest ever day, with a new high of consultations.

4:10pm: In the past hour, Dr David Turner has had 14 more patients to speak to on the phone, and four face-to-face appointments, plus more prescriptions, a medical report and some letters to read. 

4pm: Our survey is live! Please do take it here – should only take a few minutes, and make the case that general practice has in fact remained open during the pandemic…

3:55pm: Five minutes to go til our workload survey launches! Please do take it if you can – we’re keen to hear about your numbers of consultations, admin work, and more. All info here!

3:45pm: Earlier in the afternoon, the Dudley GP spent ten minutes catching up with a colleague who was on call this morning and had a list of long, complex jobs.

These included picking up things from hospital visits; chasing results; fit notes and urgent prescriptions. The colleagues needed a quick debrief, and asked themselves why things are so busy now.

All she had time for at lunch was five minutes of microwaving last night’s leftovers to have while reviewing the letters coming in – eaten with a backdrop of people queuing outside her office to discuss practice matters that need resolving.

3:40pm: A GP divulges how she finds it difficult to see back-to-back appointments about mental illness, so tries to change the order of her call list. Without this, she’d feel that patients don’t get her best.

3:35pm: Back to Dudley, where our GP is finding that some patients have waited a full year. She’s been trying to sort out referrals and tests to book for the patients seen this morning.

Looking at this afternoon’s list, she noted some with complex mental health needs, and others with symptoms of red flags for cancer. NHS 111 booked in a further patient, and she feels ‘exhausted and anxious just from looking’.

Commenting on the standard ten-minute format, she feels that ‘patients will be distressed and need time and someone to properly listen’.

During the morning alone, she had 37 emails arriving, all needing to be filtered to see if they can wait or not.

On top of this, there are a high volume of scripts to sign, although she’d also done many last night.

Each one needs assessment, because many of the patients haven’t been able to get their long-term condition reviews since this time last year.

3:30pm: Dr Dave Triska reiterates that ‘a number of patients are frustrated at access to secondary care specialty team advice’ – ‘for quite complicated chronic problems’.

He observes: ‘Almost feels like the country is waking up with the roadmap and deciding they want to get everything sorted before then. Feels in some respect like the run up to Christmas for that.’

3pm: Up North now, where Dr Kamal Sidhu is another who started work last night (Sunday, no less!). He cleared up blood results, tasks and letters, all before this morning’s surgery on call, then a staff meeting.

Dr Sidhu’s County Durham practice discussed aspects including how they can manage (or not) QOF and LTC clinics, along with Covid vaccination and everything else.

A benefit to his busy working day, however, is that he’s doing it alongside ‘a very efficient’ GP trainee. Great to see!

But now he’s off to afternoon surgery, and the day won’t end there. It will be a workers’ clinic after that.

2:40pm: A recurring theme here – we’re told by a third GP about patients asking when they and their family are getting their Covid vaccine. As well as, in this case, ‘five other things’.

2:35pm: The GP in Dudley has spent five hours and 18 minutes of non-stop consulting – and that was just the morning session.

She notes that this is 90 minutes longer than when appointments were face-to-face, and that because of presentations of multiple problems, phone consultations are difficult to assess the severity and risk, so more detailed assessments are required.

2:20pm: An update from Dr Dave Triska – he’s ‘overwhelmed by chronic disease, patient concerns about longstanding problems and delayed secondary care’.

1:40pm: The Dudley GP we spoke to earlier is still having some tech issues – the website in particular is a new problem, now the Government has asked for requests to be taken this way too.

Whilst reviewing the queries from there, she notes how Monday is the heaviest day for traffic.

Two more patients request appointments for issues that are ‘probably significant’, but unfortunately there are no appointments for them.

She’s also led three face-to-face consultations, taking a total of 90 minutes, because every patient presented multiple problems, and her office, including the chairs, couch and equipment, requires cleaning in-between.

1:25pm: Earlier, we shared an example of GPs being repeatedly asked about vaccine priority. Now, Northern Ireland GP Dr John McSparran recounts experiencing the same thing.

1:20pm: Dr David Turner checks back in to update us on how it’s been going. He’s now just finished visiting the six patients in a residential unit, and will spend the next half hour writing up notes before a practice meeting.

Consultations, both phone and face-to-face, are due to recommence at 3pm.

1:15pm: Our columnist Dr Shaba Nabi, of Bristol, started the work day at 7.30am with last-minute prep for a weekly staff briefing and looking at results/tasks.

By 8.15am though, all clinical staff were kicking off the week on a high, stretching to the soundtrack of Katrina and the Waves’ ‘Walking on Sunshine’, before swapping to listen to the brief Dr Nabi had prepared. She’s done this since the start of the pandemic, to update everyone of fast-paced changes.

Calling patients commenced at 9am – with a slow start because some patients ‘don’t get out of bed that early’!

A quick cuppa was squeezed in at 11.15am, whilst checking notes of a patient with suspected heart failure.

Shortly after, it was time to see a patient, who isn’t as unwell as anticipated, so it’s a ‘relief’ that this didn’t take more than 15 minutes.

It’s back to calls – planned and triage – by 11.45am, and a need for a bite to eat, as Dr Nabi is (understandably!) ‘starving’ by 1pm.

1:10pm: Dr Simon Hodes managed a ten-minute cuppa just to get out of his consultation room, while lunch might be a quick sandwich.

Coming up are a call to discuss a pop-up Covid vaccine clinic; a webinar about Long Covid; 17 more clinic letters that have already come through since 8am (many with ‘to do’ lists from hospital doctors); more than 25 prescription queries to look through; and training of a new practice pharmacist who’s sitting in on his first day.

1:05pm: Nottinghamshire GP Dr Prakash Kachhala shares his day so far for us. It includes arriving at 8am; actioning 21 blood results, having already done more than 50 last night to take off some of today’s pressures; meeting with practice colleagues; and a total of almost 20 consultations, split between urgent telephone and face-to-face.

1pm: We’re heading over to Watford now, where it’s a similar case of juggling lots of different tasks. Dr Simon Hodes explains: ‘It’s been a full morning here – it started with three hours on Sunday to try and get ahead and clear the decks (prescriptions; blood results; email enquiries; plus some longer emails and reports that just cannot be shoehorned into my usual 12+-hour day).

‘I was at my desk at 8am today as duty doctor – fielding calls; eConsults; accurx (SMS) exchanges; and reception queries. We have a new FY doctor sitting in, so I’m trying to spend time with her discussing cases.

‘Throughout the morning, I was also overseeing two paramedics who are messaging and calling with queries.

‘The nurses then asked me to review a non-healing ulcer. I’ve also seen two patients face-to-face, and now have a home visit for palliative care/end-of-life care.’

12:50pm: In Dudley, a GP takes a few minutes to update us on how her morning’s gone so far.

EMIS is running ‘incredibly slowly’, with multiple quits, so she’s sending us this whilst waiting for a restart.

She then encounters a smartcard error.

To get ahead, she started phone calls at 8am, but still hasn’t finished them. A patient in the patient clinic couldn’t take the call, and some patients aren’t answering the phone, so she’s been having to call them repeatedly.

By now, face-to-face patients are coming in, and despite not being on call, she needs to fit in one who only wants to speak to her.

All practice lists were fully booked by 8.30am, so she won’t have time to tackle letters or prescriptions until tonight.

Some progress – the computer is now back on. But it took 12 minutes…

12:40pm: It’s lunchtime, but in West London, Dr David Mummery isn’t catching much of a break. He’s busy signing off 68 electronic prescriptions, having made ‘a number of clinical decisions’ this morning.

These include consultations, prescriptions and results, but not the Docman letters he told us about earlier. He predicts that these will surpass 130… 

12:30pm: Dr Richard Ma shares some snapshots of his morning so far:

12:15pm: A new reflection from Dr Lisa Finnikin: ‘I never quite know where the time goes! 12pm and still five more patients to call.

‘Already today I’ve managed stress; minor head injury; polycystic ovarian syndrome; vaginal discharge; angular chelitis; pre-diabetes; breathlessness; medication reviews; eczema; palpitations; bloating; headache; and cardiovascular risk. Actually, on reflection, seeing all these written out, it seems clear why it takes me so long!’

12pm: Over in Surrey, Dr Dave Triska speaks for many GPs in fielding a number of queries from patients about accessing the Covid vaccine. He explains that he’s been dealing with four patients in a row who want prioritisation for the vaccine, which they can’t have under the current guidance.

11:30am: Back to London now, where Dr David Turner has seven patients to see face-to-face on a home visit to a residential unit between 12 and 1pm.

9.45am: Dr Lisa Finnikin updates us that all of her Sutton Coldfield practice’s morning appointments were full by 9.30am, with 30 tasks having already landed in her inbox.

So far today, she’s completed one face-to-face appointment and three out of 15 telephone triage appointments.

9:35am: Elsewhere in the capital, Dr David Turner shares a snapshot of his morning ahead. Before 12 noon, he has to get through 15 phone consultations; two face-to-face consultations; 26 blood reports to review; and seven hospital letters to read and action.

Come midday, he’ll be visiting a residential unit to undertake some more face-to-face consultations.

9:30am: By 9:23am, Dr Mummery’s on-call list had risen to 20 patients, with the screen full.

9:20am: Over in West London, Dr David Mummery is starting the morning with ‘a mixture of booked timed phone calls and on-call list’, before Hot Clinic in the afternoon.

As of 8.37am, he already has 13 phone calls booked in, 25 results processed (having cleared results on Friday) , and 13 letters in Docman.

9:10am: Similarly, Dr Lisa Finnikin from Sutton Coldfield shares how she logged on at 8.30am, having ‘been feeling nervous about working today since last night’.

She continues: ‘Last Monday, I was the on-call doctor and didn’t finish working until 10.30pm. The day felt like a ride on a precarious rollercoaster. Today, I have two clinics booked. Let’s see how the day goes…’

9am: Kickstarting the working week is Dr Charlotte Alexander, whose experience of first thing on a Monday is bound to resonate with many GPs. Dr Alexander, who practices in Surrey, tells us that upon logging on at 7am, she already had ’23 blood results’.

7am: Welcome to the live blog of today’s Pulse workload survey. We are asking GPs to log how many hours they are working today, 1 March 2021. This will help inform our April cover feature, and we will be making sure GPs’ voices get heard.

This is much needed. As we reported, GPs are being accused of being closed, and not working. We know this isn’t true, and today’s survey will give concrete evidence for this.

The Pulse workload survey will be going live at 4pm, and we will be sending our email alerts, as well as featuring it in our home page.

This page will be updated throughout the day with your stories about workload.

Read more about the survey here.

If you have anything you’d like us to feature, please contact workload@pulsetoday.co.uk