The British railway network functions very well indeed, in certain circumstances. These circumstances include no maintenance work being done anywhere on any line, perfect weather conditions, full staff presence, no industrial action and every piece of computer being software in full and harmonious sympathy with every piece of computer hardware.
Of course this has never happened. There’s always a badger with the vapours near Acton, or a box of Kleenex lying dangerously on the line at Berwick. In short; there’s no slack in the system. And this is the point at which we have pretty much arrived in general practice.
Normal days are do-able. I and all my colleagues are in, the phones work, there’s no media-fuelled health hysteria, the local hospital can probably find a bed if push comes to shove, and the number of tediously self-centred narcissists clustering round our front door is smaller than the number of surreptitious smokers.
But I can’t remember the last day like that.
Someone is always on leave, or on a course. Someone else is enjoying a half-day of ‘personal development’. Someone else has buggered off to Australia (I can’t blame them) and has yet to be replaced. The registrar is with the trainer, earnestly watching videos of long-forgotten consultations. And the whole practice is still recovering from the mandatory half-day of city-wide learning showing us how to maximise our exposure to our patients. During which we lost 110 appointment slots.
And somehow, on a Friday afternoon with norovirus in the air, a practice that employs seven doctors only has two on duty, and one of them is me.
The computer screen is a malevolent instrument of torture. At 1.30pm the list of ‘urgent extra’ appointments becomes available, and I watch them fill up in 40 seconds or so. Then they’re added into fictional time slots. The ‘tasks’ list holds five ‘urgent’ and 32 ‘non-urgent’ claims on my attention. ‘The ‘even-more-urgent’ tasks alert, which deems itself more important than anything I am doing, is flashing on and off like a strobe light. People are knocking at the door: ‘Excuse me for interrupting…’ ‘Could you look at this ulcer…’ ‘Please sign this…’ ‘This sick note is urgent or they get no money…’
Unfortunately when my patience cracks and I bellow ‘WHAT NOW?’ at the next person to interrupt, she spills my cup of coffee all over herself. ‘Sorry, sorry,’ I chunter. ‘Oh and there’s this home visit request as well,’ she says, brushing Nescafé onto the carpet. ‘Constipated for a week.’ The room acquires a red tinge and time slows down.
Some time later, the building is empty and locked apart from me and my final ‘urgent extra’. ‘It’s these tits,’ she confides. ‘They’re not big enough. I’ve been meaning to come for a while. My friend is getting hers done on the NHS. She said you would write me a letter too.’
‘She was wrong,’ I say, rolling down the shutters. ‘But look at them!’ ‘No.’ ‘But my friend said…’ she protests as I gently prod her out of the room with my medical bag.
‘She was wrong, she was wrong.’
Dr Phil Peverley is a GP in Sunderland
