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One day on the GP frontline, and it never stops…

Online and on the frontline of health care. Photo credit: National Cancer Institute / Unsplash

A doctor speaks out anonymously about the exhausting challenges they face on a daily basis. All examples have been altered to maintain patient confidentiality.

7am Monday morning, a few days after Storm Eunice raged through Britain and I’m sitting in front of a blank screen in my GP office. I have come in early to try and catch up on a mountain of paperwork. During the heat of the storm on Friday the Sussex NHS server stuttered and, for most of the day, all the clinicians in our team were sharing one functioning computer in reception where we took it in turns to write up our notes and check who we were meant to be calling. We’d cancelled face-to-face slots with our most vulnerable patients, fearing that bringing them out in the storm would risk more harm than any benefit we could possibly offer in their long awaited 15-minute slot.

So I assume the IT glitches will have been fixed over the weekend but sadly not. No doubt a requisition note has been sent up the line for an IT call-out, but we all know that won’t happen anytime soon. I manage to log on to my shared NHS laptop (we have about eight to share between our team of 25).  Working from home is impossible without a laptop so the pandemic has been testing. We were told at the beginning of Covid by our Clinical Commissioning Group we would all get one each but when the first consignment arrived several months later with Chinese keyboards and then the second consignment was made up of empty laptop bags, our expectations were lowered. 

A team of engineers starts drilling

Luckily, one of the reception team arrives and manages to fix my desk top computer by turning it off at the wall. Unfortunately, this also turns out to be the day the alarm is being fixed (it broke six months ago) and a team of engineers starts drilling outside my door while also knocking out the phone lines intermittently. But this doesn’t prevent the patients getting through to request a GP call the minute the phone lines open at 8.15am. All bookable appointments are snapped up in minutes and the duty doctor list starts to extend down to the bottom of the screen and beyond.

The legacy of Covid and the pressures of increasing costs of living are stark in the list: “feeling very anxious, hasn’t been out alone for over a year, suicidal – please call”; “child has been waiting over a year for ADHD assessment, not sleeping, Mum is exhausted – please help”; “pain in hip is excruciating, hip op still not scheduled asking for more morphine”; “can’t afford heating which has flared fibromyalgia pain – please advise”; “cough and breathless – definitely not covid as did a test last week”; “new medication started yesterday causing side effects – can she stop?”; “pain in R kidney area, has googled and thinks has LPHS syndrome – would like urgent referral”; “Mr G has fallen out of bed again – carer has covid and can’t go in” and on and on it goes.

My colleague is dealing with this list while my first job for the day is the admin. This involves writing urgent child protection reports needed for conferences to be held in the following days. The police have alerted social services to a household in a terrible state – unclean and unsafe for the children who had obviously been left unattended there. Social services need a GP report on each member of the family: any signs of injury, abuse, mental health issues, drug/alcohol in the parents, any appointments not attended, vaccinations missed. 

A pile of e-consultations have arrived

I also need to sign off all the prescriptions, sending messages to the patients over-ordering benzos and morphine as I go along, phone the coroner to discuss an unexpected death, check all blood results and hospital reports and respond to the pile of e-consultations that have arrived – often with photos of the offending in-growing toenails, weird rashes and spots that people want to share with me. 

I then dash out to visit an elderly man I have known for over ten years. He has been diagnosed with a degenerative condition and over a period of months has become bedbound and dependent on his daughter-in-law for care. She is doing a great job but he is in pain and obviously frightened and the most important thing I can offer is a familiar face in this difficult time – someone who cares about him. This is what general practice was really about when I started many moons ago – looking after families from cradle to grave and listening to them in their hour of need. It is now so much more and sometimes feels like these missions get lost. When I get back to the Surgery, I refer him to the palliative care team and the community nurses – we will all do our bit and work together to ease his load. 

At ‘lunchtime’ we have a meeting with a new team from our primary care network (group of local GP practices working together) to support patients who are high intensity users of both general practice and A&E. I would like to think this is all about helping them to explore their unmet needs but of course it is also about ticking boxes to try and reduce NHS costs. Great work is being done to support them, but for some, the entrenched habits caused by previous traumatic experiences or being poorly parented as a child, often with deprivation and poverty, means their personal health literacy is very low. 

8.30pm and I am completely done in

Then it’s on to afternoon surgery. A woman attends for the fifth time since a road accident at Christmas, with a different pain. She has had cancer and has early dementia – I’m trying to work out what all these pains could be. Next up a man I have known for years: I looked after his wife until her death. His diabetes is out of control because he isn’t looking after himself and his arthritis is making it more and more difficult to get out of his second floor flat. 

A woman brings her 24-year-old son with anxiety – he spends most of his day playing computer games and has never worked. A 70-year-old woman is brought by her husband: she is hearing voices again. We have been here before and I know them well. I know what works for her. Several people spend their first five minutes explaining to me how difficult it was for them to get an appointment and how awful it is that GPs won’t see people face-to-face anymore. I know. I sigh. I grit my teeth. In the occasional spaces when people don’t turn up or don’t answer their phones, I help my colleague out – they are still wading through the duty list and we both spend the last hour of our day finishing it up. 

I finally get home at 8.30pm. I am completely done and am entirely unsympathetic to my own family’s ailments. Luckily, they know better than to ask and just pour out the wine.  

The British Medical Association says that 25 patient contacts per day per GP can be deemed safe. By the end of our day my colleague and I have seen, spoken to and responded to over 90 patients between us. 

And tomorrow we start again. 

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