A WEEK IN THE LIFE OF A G.P.

Dr. C. Dollery

I thought it would be of interest to people to know how GPs spend our time in the practice, so when you see us whizzing around the place you know why! 

My typical working week is as follows:

Mondays:  I have become a GP with a Special Interest in Mental Health for the local Primary Care Trust (PCT).  As part of this, I am the clinical lead for a major project developing a new service which will allow quick access to psychological therapies, starting from next April.  This sometimes means I have to attend training courses, give lectures or work with different organisations on the days I normally see patients – so bear with me over the next 2 years! 

Tuesdays:  I arrive at work at 9.00 after the school run.  Other partners start from 8.00am onwards, arriving at the practice from 7.30 am onwards.  I see 15 patients over 2.5 hours.  We offer 10 minute appointments, as part of our NHS contract, though complex cases can take a lot longer.  Thank you to all my ‘patient’ patients who are willing to wait for me!  Often we have a number of extra patients (up to 5 each) added on to the end of morning surgery, allocated fairly across us all.  This means that I usually finish seeing patients by 1pm or later.  I dictate referral letters as I go.  In addition, there are usually half a dozen messages from patients to work through and act on.  I finish these off after surgery, taking me up to 2 pm. 

During morning surgery, our receptionists liaise with the first on call GP and all the home visits are allocated.  We usually get anything from 1 to 5, depending on the time of the year, and Mondays are usually the worst (unsurprisingly).  So I pick up my notes and drive off to see my housebound or acutely unwell patients who can’t get to the surgery.  Sometimes, as first on call, I am called out on emergencies during my morning or evening surgery and this can create additional pressures.  If I have time I grab a sandwich ‘on the hoof’. 

On my return, I either go straight into evening surgery (starting at 3.50), or catch up on other paperwork, such as letters received from hospitals on patients, results, professional or patient letters, all of which have been scanned onto our computer.  Often on a Tuesday (having had my last day at work on Thursday) I can have 70 letters to get through, as well as 50-60 results.  Urgent results are obviously seen on the day we receive them, and acted on by the first on call GP or the GP who originated the request.

Evening surgery is 2 hours long, so around 12 patients, followed by more paperwork and messages. I usually leave the practice at 7.30 to 8pm.

Wednesdays:  follow a similar pattern, but on top of the normal clinical workload I attend any joint meetings about our psychiatric patients with our in-house psychiatrist Dr Acharrya. 

Other duties include supervision and training of our junior doctors and nurses, with occasional tutorials; lunchtime meetings about clinical issues or partnership business; and we meet fortnightly in the evening to have formal business meetings, often ending at 10.00pm. 

Thursdays: I run my drug and alcohol clinic, part of a shared care agreement with the specialist services, and which I have been doing for a number of years. I have joint surgeries with one of the Drug and alcohol nurse specialists once or twice a month. 

All GPs in our practice have specialist interests:  for example: gynaecology, dermatology, minor surgery, training, osteoporosis, mental health, palliative care, medicines management, diabetes, respiratory disease. 

We ensure that all doctors and nurses receive up to date training and guidance on every aspect of their role.  This is an ongoing process and requires us to attend external courses and be reaccredited in the many skills we perform.   We hold regular “Educational Evenings” at the practice and run these with hospital consultants and specialist clinicians.  All GPs within our PCT are invited to attend and the turnout is usually high.  These usually commence at 7.30pm and last all evening.  Fortunately food is provided!

In addition we all attend various PCT meetings relating to commissioning of new services (such as our in-house gynaecology clinic); medicines management; or issues to do with our planned new build. 

By Friday:  I am generally very happy to have my day off (though I often find myself on courses or doing paperwork at the practice, but at least it is in my control how long I spend on it!)

I should point out that I am a two day a week Partner at the practice!  My fellow partners range from part-time to full-time and all have similar weekly demands.  

High quality achievements

I am proud to say , for the third year running, we have achieved maximum points under the Quality and Outcomes framework (QOF) relating to clinical care and organisational expertise with the new GP contract.  Last year we were the highest achieving practice in the whole of Mid Essex.   This is due to huge efforts from all staff in the practice, ensuring all systems continually get improved and recording is accurate, as well as testament to the work of all the doctors and nurses:  everyone works to very high standards.

We are the only training practice within the locality.  In order to provide training to both prospective GPs and Nurses it is a requirement to pass three yearly practice inspections.   These inspections are run by a team of professionals from the East of England Deanery and involve detailed and lengthy inspection of our systems, processes and work undertaken.   In July we undertook the formal inspection and the subsequent feedback focused on our excellent good practice and endorsed our reputation as a leading and outstanding practice.