- A typical day in the life of your GP
This is a typical day in the life of a typical GP in the NHS.
06:15. Alarm goes off.
07:15. Leave for work – taking flask of hot drink and sandwiches.
07:30. Arrive at the practice – turn on PC (ten mins to load) and check in-house emails and messages/tasks from previous day(s).
08:10. Start morning surgery – mixture of telephone appointments, face-to-face (F2F) and e-consults.
Some patients need to be seen F2F, especially if unwell and/or need to be examined. So they are booked in for later that day or another day soon. Some you can manage with use of a text message sharing of photos (or web-cam).
Appointments are timed for 10 minutes in most practices.
Face-to-face (F2F) appointments – these are either patients one of the GPs has spoken to, or some booked directly by reception: for example, new Mum and baby checks, new lumps found, abnormal bleeding, chest or abdominal pain, unwell babies under one.
In the 10 minutes of each consult, we greet the patient (or check ID if on phone), get the history of the problem (+/- examine them if F2F), formulate a working diagnosis, decide on course of treatment, check allergies if prescribing, check interactions with other meds, arrange a suitable pharmacy to send the prescription to (this being done electronically since COVID), and discuss how we will follow up. You try doing that in 10 minutes!
OFTEN APPOINTMENTS TAKE LONGER THAN 10 MINUTES, especially if there is complex medical history, elderly patients on lots of medications, mental health issues that require sensitivity.
Referrals for a specialist opinion to a hospital consultant (about 1-2 per clinic) can take 10 minutes each. So there isn’t time to do them in clinic. They are somehow fitted in later. They are recorded as a task, to avoid being forgotten!
E-consult requests – again, some need to be seen/are not simple and need calling back then and there; or information/sick notes sent through electronically, or appointments to be arranged at a later date. It is still work.
Most GPs have 20 x 10 minute ‘slots’ per clinic (i.e. 3 hours 20 mins .. yes a long time to concentrate) which are used flexibly depending on patient requirement. So if there are 2-3 complex patients, they can easily run over to 4 hours. But we (hope!) to have finished the bulk of the morning surgery by:
11:30. Time for a drink from the flask!
Breathe in. Next job. Then we triage home visits (up to 3 requests per doctor each day). These are housebound patients with medical problems. Some can be managed safely having spoken to them without need for a visit.
But if they need a visit they are allocated to an experienced Advanced Nurse Practitioners (ANPs) or Paramedic, or to the relevant GP in the case of palliative care requests. We might also need to arrange paperwork following a death which can only be completed by a GP
12:00. Do personal call backs to patients – that each GP feels they should follow up themselves – for example, a young man with depression starting some medication; an elderly lady having had repeat blood tests; getting in touch with a patient to see if his blood pressure has improved; or offering condolences to a patient whose spouse has died.
These are usually a telephone call, maybe taking 5 minutes each. With new IT, we can now use also text as a means of communication for such issues. This is especially useful for workers.
12:30. Time to check the ‘task’ list – perhaps 10-12 messages by now – from admin staff/secretaries/District Nurses/Health visitors/Physiotherapists/Palliative care team, and some that we have generated ourselves as ‘reminders’ to contact or do for patients.
Some are more urgent than others. For example, we might have a request from District Nurses for antibiotics for a catheterised patient; or a message from Palliative care nurse to do an urgent prescription for End-of-Life care.
We also need to sign off our prescriptions. This is a list of between 30-100 digital ‘signatures’ to do every lunchtime. Some practices have a ‘GP of the day’ to do them all .. no mean task.
13:00. Meetings (usually virtual). Many practices have ‘partners meetings’ (lead GPs) on a Monday and a clinical meeting for the whole team on a Wednesday. These last an hour or so.
They range from safeguarding training/discussion of complaints or significant events/how are we were managing the COVID vaccine clinics/staff shortages and recruitment/new drug uses/discussion of our patients on the palliative care register/outside speakers regarding new services of benefit to the patients. Anything and everything, actually
Eat lunch at the same time ..
14:00. More tasks. We might have time to do more tasks or check bloods (30-60 results per doctor to check most days); or make a start on the 1-2 referrals that have been generated in the morning (and perhaps 1-2 from the previous days afternoon clinic) to be typed up and sent by our secretaries; see above).
14.30. Start afternoon surgery
Again this is a mixture of phone contacts and F2F. Again each allocation is 10 minutes but often things take longer.
In the course of the day, we are also routinely required to deal with urgent queries – e.g. from the community nursing teams who have urgent requests, but also ambulance staff, social workers, coroner’s office, occasional hospital doctors all call up; and we try our very best not to keep these colleagues waiting. This might be why you might wait a little longer outside the door of your GP!
17:30. Surgery over .. phew! We now try and finish checking the blood tests, scans and referrals, we have requested (started earlier on in the day).
For example, we might find a report about a spread of a cancer, so we will call that patient to talk about it then and there. Or we may find a really abnormal blood test which will need to be repeated. Again this will require a. arranging it and b. contacting the patient.
We will also now check our pigeon holes for reports that need completing. These can range from solicitors reports on an injury, a patient wishing to join the police, a letter regarding a bus pass or holiday cancellations or to aid a patient claim benefits. These take about 5-30 minutes each.
18:30-19:00. TIME TO GO HOME. Phew again!
What the score? ..
Most days we have between 45 and 50 ‘contacts’ with patients in a day. We will do, on average, 3-4 referrals; checked 40 blood test results; signed off 50 prescriptions – and dealt with a further 12 tasks, and done a couple of reports. The possibility of error is high, in all this ‘white noise’ of work. This is why its not wrong we are paid well (and need to be highly insured).
Hope my other half has got the supper on.
21:00. Go to bed .. knackered but fulfilled (usually) ..
Summary
We have described a a typical day in the life of your GP in the NHS. Wo. Mm .. yes, quite tough. Could you do it? Maybe we all should moan a bit less regarding how hard it is to get an appointment. Can you demand to see your solicitor F2F today?
.. now if you want to be a GP, you know what it may be like.
