What Really Happens Behind Closed Doors In A GP's Surgery

27/01/2017 16:02
Rafe Swan via Getty Images

There has been a recent fuss about GP opening hours, largely, I believe, to distract away from more important issues in the NHS related to funding, workforce and demand. For a brief moment, before the media chose to focus elsewhere there was attention placed on the working day of general practitioners. What may lie at the heart of some of these arguments is a lack of understanding about what GPs actually do in their working day.

On a typical working day I am expected to see at least 34 patients, 16 in the morning, 18 in the afternoon, in two 3ish-hour clinics, though I often see more emergencies. These are the times I consider my door to be "open" to the public. Accounting for running a bit behind I probably spend about seven hours seeing patients face-to-face. But my working day normally starts over an hour before my first patient arrives and can end over an hour after the last one leaves, with a gap in the middle. I probably have, on average, 11 hour days.

So what do I spend the other four hours doing, behind closed doors?

When I am not seeing patients in the surgery, I am often speaking to them on the phone, either because they have not been able to get an appointment or because they feel that their question can be answered without being seen; though this is not always the case - rashes are particularly difficult to diagnose over the phone. I also see patients in their own home, a time consuming process which can leave you without the relative comforts of their clinical record, computerised safety check of prescriptions, chaperones and second opinions.

Apart from a short break to have lunch, though many GPs each lunch at their desk while working, I spend time at meetings with my colleagues and other health professionals to discuss terminally ill patients, problem cases, children at risk of abuse, new clinical policies and local incentive schemes. Putting aside the patient contacts outside of the scheduled clinics and meetings the rest of my time is spent in front of a computer screen.

The number of GPs in the UK is going down. But the number of consultations done in general practice is going up and the average length of each consultation is also increasing. Furthermore, the amount of administrative work done by a GP has also gone up in recent years. This includes checking and signing prescriptions and reading letters sent to us by hospitals, social services, police, ambulance and patients themselves. You don't know whether a letter needs reading until it has been read; then you need to work out who needs to know about it and if further action needs to be taken.

Patients discharged from hospital, or seen in clinics, often have changes made to their medication; this can sometimes be because they forgot to tell the hospital doctors what they were taking, there can be mistakes, or medications can be changed for clinical reasons.

Other information that GPs have to deal with includes results of tests ordered by the surgery (also on the increase), as well as the results of tests done in hospital. If a colleague is away you may have to spend time working out why a test was ordered and what needs to be done about a result, even if it is normal. Within our computer system there is a method for sending messages to each other about patients, reminders, questions, queries. These all need to be dealt with, as well as the incessant barrage of email communication between doctors and wider organisations.

On top of all that there are requests for reports from the Department for Work Pensions, as well as insurance companies that need dealing with and number-crunching associated with schemes that pay GPs for their performance. Payment is dependent on the right computer codes being used in patient's clinical records, so many records have to be reviewed to ensure that the surgery remains financially viable into the future.

Every now and then I use the toilet.

If I don't get everything done, I have to leave it to the next day, knowing that there will be even more. Alternatively, I log on to our computer system from home, after I have said goodnight to the children, and continue with the paperwork. So the work continues, to try to maintain high standards of patient care, even when my door is closed and I don't have a patient sat in front of me.