Ever since the first lockdown, Amazon has taken over my household. Alexa enjoys prominent positions in our kitchen, dining room and two of the bedrooms. I no longer plan kids’ birthday gifts weeks in advance because Amazon Prime can deliver a wrapped present the following day. I don’t even have to delve into my purse to find my debit card, as one click of my phone takes care of payment. Waiting is a thing of the past – I can watch an entire boxset on BBC iPlayer when the series is still being shown weekly.
Unfortunately, this instant-access Amazonian culture is having a knock-on effect on GP demand. E-consults come flying in over a weekend when, after a few drinks, a patient decides to seek help on a Saturday night for the slightly curved toe they’ve had all their life.
A typical GP working day now lasts at least 12 hours. If, 20 years ago, someone had told me I’d be working solidly from 7.30am to 7.30pm I’d have laughed in their face. I used to go the gym at lunchtime and be home by 6pm to breastfeed my kids. And in terms of pay, we missed a trick by allowing our workload to be measured in sessions, rather than hours. We’re working full-time hours at six sessions per week but receiving a part-time income. Our workload has increased, and our days are longer, but our pay has remained the same. Like frogs simmering in hot water, we haven’t recognised that we are now at boiling point.
There are numerous reasons for the higher workload – the shift of tasks from secondary care, patients’ increased complexity and lack of self-care skills, defensive practice, and now the post-pandemic mental health tsunami. I now feel efficient if I complete a consultation, including documentation, within 15 minutes, although this is 50% longer than scheduled. Consulting now takes up at least eight hours a day, and then we spend another four hours in meetings, visits and drowning in paperwork.
What puzzles me is why we are never ‘saved by the bell’ like other professionals. I recently attended a virtual parents evening, on a highly efficient platform called SchoolCloud. My appointments with teachers were clearly listed, I had seven minutes with each one and I got a one-minute warning before being cut off. GPs could be a bit more generous and offer 15-minute slots, but I can’t help wondering if this type of approach would concentrate the minds of doctor and patient. After all, therapists terminate sessions mid-weep at 55 minutes.
GPs have no such boundaries on their time. Our open-ended contract means we’re expected to absorb limitless patients for limitless time. And despite the relaxation of lockdown and the expectation of GP business as usual, we are still bound to emergency legislation obliging us to take on patients from the urgent care setting on top of our usual workload.
The balance between ensuring equitable access and increasing patient traffic by opening new lanes of the GP motorway is now definitely skewed towards the latter. And we will be mown down unless we manage to introduce some traffic-calming measures.
Dr Shaba Nabi is a GP trainer in Bristol. Read more of Dr Nabi’s blogs online at pulsetoday.co.uk/nabi
This piece originally appeared in the July print issue of Pulse