Profile: Dr Phil Smith
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Career 2006: Qualified in medicine
2013: ST2–ST3 placement at north-west London practice
2014: Salaried GP at the practice
2016: Joined the partnership
Roles GP partner and practice lead on chronic disease, homelessness and education. Applying to become GP trainer
Hours worked Six clinical sessions per week, plus extended access commitments
I arrive at the surgery and catch up on e-mails. Since becoming a partner, I allow at least half an hour for admin before morning clinic. There are usually some patient letters, requests and queries that need a clinician, and it helps the management staff to sort them first thing.
The first clinical session gets under way. This morning I’m on triage duty at the front desk, a system I recently helped set up to improve access. The second patient I see is annoyed: we’re not winning with his asthma and it is affecting his job. After taking a brief history I book him in for further investigations with our physician associate (PA), who leads on respiratory work locally. I’m struck by how my approach has changed since becoming a partner; as a salaried GP I would have managed the patient myself, whereas now I am more aware of the expertise available for the practice to draw on and more confident to make use of it. This way, the patient benefits from being seen quickly for a thorough assessment, while GP time is freed up to see sicker patients.
Clinic over, I go back into admin mode. The first job is to call an engineer about the broken air conditioning; the practice manager is away today so it’s a case of stepping up to the plate. Our partnership rents the premises – I am a joint leaseholder – and it was a surprise when I transitioned to partnership to realise how much extra responsibility this involves, maintaining everything from blood pressure monitors to toilet roll holders and security door codes.
I chair a meeting with the CCG diabetes management team to review our complex diabetes patients. Since becoming a partner, I now lead the practice’s work on diabetes, cancer, palliative care and enhanced services, which includes working closely with 12 neighbouring practices to pool resources and shape local pathways. The responsibility can be quite daunting, but my senior partners are very experienced with commissioning, and forthcoming with support and advice.
I grab a sandwich at my desk while updating some enhanced service work. Being the practice co-lead has made me much more attuned to getting the most out of each patient’s visit, both in terms of patient care and practice income.
During afternoon surgery, I discuss a tricky case with the GPST3 I’m supervising. A district nurse has requested a home visit to a palliative care patient; we agree the likely outcome and arrange hospital admission instead, discussing the grey areas of palliative care and the limits of our practice.
Becoming an education lead has been the most rewarding aspect of partnership. I enjoy the interaction with students and trainees and seeing them progress; it also strengthens confidence in my judgment, and my value to the practice.
I head to our fortnightly partners’ meeting. We are to lose two registrars at the end of the month, so we discuss how best to staff clinics and on-calls, and who will supervise our new FY2 arrival.
We also discuss a plan to hire two new PAs. We have to consider what impact this will have, not only on the overall budget, but also the profit for partners.
It has been a steep learning curve picking up the business side of partnership, and how we interact with commissioners. When my partners discuss meetings with the CCG and various committees, I often think, ‘I don’t have a clue!’ It’s quite humbling – but also reassuring – that senior colleagues have so much knowledge to pass on.
I finish my notes and referrals and find I’m last to leave. In the car, I reflect on the meeting and start to consider new ways to join up care across our neighbourhood. I get a real sense of satisfaction knowing I’m now part of the practice ‘family’ and looking forward to sharing in its future.