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Alexa, why am I working a 12-hour day?


Alexa


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

READERS' COMMENTS [11]

John Graham Munro 16 July, 2021 10:00 am

Stop moaning——-you’ve just been awarded the George Cross medal

Turn out The Lights 16 July, 2021 10:57 am

And they spent some of last year banging pans and clapping your efforts on a Thursday.Now you have to open normally in the tail end of a pandemic where a significant number of covid cases are to those with a double vaccine or a reinfection.Do a booster programm limitless les’ and des’, QOF etc etc all with pay restraint the limit on the lifetime allowance and a likely raise in taxes with a restriction on funding.Also acting as ‘front of house’ for a failing health care system to aggressive and entitle patients. Whats not to like!

Tj Motown 16 July, 2021 12:55 pm

Amazon Prime – delivery by end of next working day – £79.99/year
E-Consults – response by end of next working day –

NHS 111 are asking me to see patients within 1 hour as well on the CAS slots. I am wondering if that really constitutes general practice and not emergency care. Although it is for an emergency cholesterol level of 6.3, the patient and call operator were very worried. Sigh.

Patrufini Duffy 16 July, 2021 2:18 pm

The Seretide banner on the side reads “turn down their symptoms”.
I like to think it’s more like “turn down their mind”.
Like a ping-pong machine ones current role is to deflect early, reintroduce a 2 week wait time, permit nature to create some sort of story and await a potential DNA. Furthermore, minimise any follow-up and place serious value on it – like a trump card worth £120. Time is life – remember that. —— * If you spent 15 minutes more at work every day – that is 3,600 minutes a year. Which is 7.5 (8 hour working days of a standard job).

7.5 days – for free. That is nauseating. Whilst the NHS laughs on at you.

James Cuthbertson 16 July, 2021 7:26 pm

The dermatology department where I work pays locum consultants £80 a patient. And they only see 2ww which takes about 5min. The consultant today earns £1200 for a mornings work- about 10 times less stressful than your morning. General practice is being taken for a total ride.

Cameron Wilson 19 July, 2021 10:35 pm

Agree with JGM to a point, am tired of us moaning, no one likes a whinger! Far better to face reality and realise we are a lost cause when it comes to expecting either patients or HMG,NHSE or other lackeys to give a monkey’s! Plenty other countries seem to have a better satisfaction level for both doctors and patients not to mention better health results, give us an option you “Leaders ” stop denying reality!

Steven Hopkins 22 July, 2021 8:11 am

I am afraid CW’s response above highlights the reason we are in such difficulties. It is not up to our “leaders”, it is up to us to seek the options that suit us best. If you are not enjoying what you are doing, go do something else instead. You are a highly educated, sensible human being able to solve problems for your patients. Why are you unable to do the same thing for yourself?

John Graham Munro 22 July, 2021 9:27 am

Steven Hopkins———at last.—– despite the vitriol I receive, people are beginning to agree with me

David Jarvis 22 July, 2021 9:40 am

Turn off e-consults. One way of accessing appts is about as equitable as you can get with access. Multiple lanes as in a motorway encourage queue jumping and weaving. Increase frustration with evidence of little gain in forward progression.

Cameron Wilson 22 July, 2021 9:00 pm

Steven , and if I wasn’t going to retire from this nonsense in the next few months would totally agree! Just feel sorry for the younger colleagues that there does not appear to be any alternative on offer!

Satish Mummidi 24 July, 2021 10:34 am

I agree with Dr Nabi. 12 hour work days have become very common in General practice and it is demoralising the primary care phyicians, especially as more & more of what used to be secondary care workload seems to imperceptibly shift onto primary care. Although GP trainee numbers are purported to be increasing we are not seeing any new GP availability in real terms. I think NHS top management needs to incentivise primary care and address the GP workload if they would like to avoid a sudden collapse in a chaotic heap, of primary care and by default the NHS. All said and done the NHS is still a great health service but needs a lot of help from every corner to support the work force deliver the best care possible to our patients in a timely and efficient manner.