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Diary of a part time GP, 7 April 2022

A glimpse into the future?

It was going to be another scorcher today – the thermometer indicated 22 degrees and it was only nine o’clock in the morning. At least I was indoors and the sun didn’t get to my side of the apartment block until after midday.

I sat down in front of my laptop and prepared for the morning’s work. I was on duty for five hours and had responsibility for a small percentage of over fifty thousand patients this morning.

As usual, my first task was to read the morning journal. This was a daily update on what major events had happened the previous day and what was expected during the current one.

There were the usual problems. Another measles outbreak was happening in the area I was covering so clinicians were advised to be extra vigilant when dealing with young children with a rash, temperature and catarrhal symptoms. Despite all the publicity over the past ten years some parents were still not having their children vaccinated. There was also the ever recurring warning that both local hospitals were on Red Alert and were at capacity so could primary care clinicians ‘please consider alternative options before admitting patients.’

Yeah, right I thought. I’d be happy too if you contributed to my medical defence subscription.

The next job was to start going through the fifty or so emails from various patients regarding medication queries, symptom updates and general advice. This particular task was usually straightforward even though I rarely have previous knowledge of the patient. This is because my current role is to offer remote consultation advice purely based upon what is in their medical record and their particular query. With complete access to the records it is a simple matter for an experienced GP to offer advice via email or, if needed, arrange a telephone consultation with a GP from the patient’s locality who could then see the patient face to face if needed.

I can normally get through one email every six minutes, so with fifty in my inbox I ran to schedule this morning, despite the number of home visits I had to cover.

As a result of the drive for the NHS to embrace telemedicine, I am also covering a proportion of home visits and usually have about ten of these to deal with in addition to the mentioned responsibilities.

Just as I started on the first email a pop up alert appeared on the screen and I was needed to advise a Nurse Practitioner who was on a home visit to an eighty-nine-year old man with multiple co-morbidities and who was having breathing problems.

The clinical software automatically brought up the patient’s records as I accepted the call and I was then presented with multiple screens showing the high definition camera image of the patient, another image of the nurse practitioner, the medical record, current biometric measurements of blood pressure, pulse, O2 sats, temperature, blood sugar, ECG and urinalysis.

‘Hi Hadrian, thanks for picking up the call, I bet you’re warmer than I am because its freezing here!’ said Jenny, ‘This is Mr Partridge, who as you can see is breathless, has a cough and a temperature. I’m a bit worried about his chest pain. His ECG is fine and I thought he had a simple chest infection but his pains are pleuritic and his sats are down and I think he might have pneumonia because his left base has reduced breath sounds and is dull to percussion. I think he needs admitting for bloods and a chest X-ray.’

I’ve spoken to Jenny a number of times over the past few weeks and I knew she was very competent. I agreed entirely with her diagnosis and gave her the all clear to go ahead and admit Mr Partridge.

I still find it astonishing that a nurse practitioner in 2022 can’t admit a patient to hospital for further investigation without a GP saying its OK. It’s to do with money as the CCG won’t sanction nurses making decisions that cost a lot of money. So they’d rather pay me to be on the end of a phone instead.

I wished Jenny well and left her to make the admission arrangements and told her to drive carefully. It’s another miserable long winter in England and there had been more snow overnight.

I settled back to the patient emails, thankful I’ve taken early retirement and only work part time now. The drive for telemedicine had been such a great success and, after all, how else could I work remotely in the UK from Cyprus?

Dr Hadrian Moss is a GP in Kettering, Northamptonshire. You can tweet him at@DrHMoss

This article was first published on Dr Moss’s blog