Day in the life of a GP - staggering caseload, stressed colleagues and constant demands

A GP has described a typical work day amid a crisis of morale among the nation’s family doctors. Dr Tamara Keith, a partner at a practice in Bottisham, Cambridgeshire, has described how workloads have soared and are now unmanageable. The General Medical Council announced earlier this month how workload pressures are behind why GPs are struggling to care properly for patients at least once a week. The regulator’s poll of more than 4,600 doctors found 60% of GPs said they found it hard to provide patients with “sufficient care” every week. Some 73% said delays to providing care, treatment or tests was the main reason. The Royal College of GPs says there are now on average 2,300 patients for every qualified full-time equivalent GP in England - a 13% increase since 2015. Over the last decade, more senior GPs have taken early retirement due to unmanageable workloads. Today the Mirror publishes Dr Keith’s diary outlining a day in the life of a family doctor on the NHS frontline. A day in the life of GP partner Dr Tamara Keith* 6:56am: Unlock the surgery, unset the alarm, check the building for anything unexpected over the weekend. Today I am the triage doctor for Monday morning. I will deal with all incoming requests for appointments and decide the priority of these requests. I will see any emergency walk-in patients, review all the abnormal pathology and radiology results and complete any urgent actions, read all letters from hospitals with urgent tasks to be completed by the GP. 7:06am: I have 169 blood test results to interpret. Some blood results require urgent action today so I need to be alert to any abnormality and exclude the causes where swift action can make the difference between life and death. Some indicate new acute kidney injury. Is this because of the hot weather and the patient hasn’t been hydrated enough or have they had a reaction to medication or is it because they are seriously unwell in another way? Another patient to add to the list of phone calls and the lines haven’t even opened yet. I also have 25 questions about patients from other colleagues and six letters to review with jobs to complete. 7:40am: Three blood tests indicate possible bowel cancer, one possible prostate cancer , and one an abnormal X-ray which requires a phone call to check on the patient. For six on my list I must arrange phone calls for or see in person and the triage isn’t even open yet for the day. I’ve got six letters to go through and two are safeguarding concerns from over the weekend raised by out of hours service, ambulance or police. I need to decide what level of concern there is and if action is needed today and if not, then when. Our reports are used to influence decisions about whether children stay with their parents or are taken into care. They take hours to write and are critical to the future of that family and child so cannot be rushed. I have no additional time for this. I just squeeze it in. 8am: Phone lines open. I only have 17 GP appointment slots this morning and three nurse appointments for minor illnesses. 8:10am: I have 22 requests on my list so far which is two more than I have slots for and we are 10 mins into triage opening. 8:20am: Someone has turned up at reception saying they need a doctor urgently, they have chest pain. We are not an A&E but how can I turn them away? One of my health care assistants completes an electrocardiogram (ECG) and then I review the patient but this means 20 minutes lost from reviewing the triage queue. 8:46am: I have 44 triage requests to work through. All these patients believe they need an appointment and most want that appointment today. Of these 19 so far will require a phone call from me as there are not enough slots. 8:50am: Receptionist calls, a lady is at reception in tears, her husband has just been diagnosed with cancer and is in pain, is Dr Keith available? Can I see her? Of course. For now time stops, she is my priority. A hug is needed. Comfort offered, home visit arranged for over lunchtime. I know this family well, continuity of care gives the greatest pleasure. Being with patients celebrating moments of joy but also support during moments of despair. Now 51 requests for appointments on the triage list. 9:11am: An urgent phone call request, husband of elderly lady with dementia who is dying at home. She needs an urgent visit. Reassured over the phone that I will come over lunchtime. 9:20am: Now 60 appointment requests. 9:24am: Patient triaged to a physio appointment. They are not happy beacuse they want a GP. Another phone call to add to my list. 9:44am: Nurse instant messages, can I review a diabetic foot. 10am: Two hours after triage opens no appointments for the day left. Any booked beyond these two slots I’ll have to call myself or see before I leave. 11:45am: Practice manager knocks on my door, there’s been a complaint. Letter received from someone who would like something removed from their record. They disagree with what a colleague has written. I must review the letter, review the notes and speak to the colleague to understand what happened. I must call the patient to understand their concerns and what their expected outcomes are from the complaint. 12pm: Collate 11 letters which have come in today and now have 105 blood results to do for other GPs off. I also have 37 medication tasks which is when dispensers can’t issue medication as there’s an issue. Possibly the drug is not available or maybe the patient has requested morphine only four days after they last did indicating overuse and possible addiction. This is a massive time waste each day. I must research what may be a safe alternative if the medication the patient usually has is no longer available. Appointment requests now up to 88. The requests coming in are varied: acute back pain, shortness of breath, palpitations, new rash, painful swollen ankle, blood sugar reading high in patient on insulin, child with a fever, baby who won’t stop crying, daughter calling about her elderly mother who is confused, depression, sick note request, anxiety, headache… man worried he has skin cancer, a patient with advanced cancer who is scared. 12.40pm: Ate lunch for ten minutes whilst discussing upcoming visits with a trainee. Lunch period at the practice is the time between morning surgery ending at noon and afternoon appointments starting at 2:30pm. I do two palliative care visits with a GP trainee observing me. There are other home visit requests to our local care home which other colleagues complete. I love home visits as they offer a window into a patient’s life you cannot get at the surgery in a ten-minute appointment but they are very time consuming. Over today I will do four. 2pm: Arrive back at practice and have half an hour to interpret the nine blood test results that have appeared during the day. I notice 11 letters have appeared since this morning requiring GP action, onward referrals, new prescriptions or new blood requests. 2.30pm: Afternoon clinic begins and has 14 patients booked in for face to face appointments of ten mins each. Some will take far longer. Many will come with a list of at least four issues - 2.5 mins per problem! 2:45pm: A knock at the door, a colleague is feeling stressed, they are tearful. “Take a seat, how can I help?” The 2:30pm patient will have to wait a while. 3:15pm: I observe a trainee complete a phone call with an elderly lady who lives alone with joint pain. She is worried she will fall. She can’t really hear us on the phone. It would be safer to visit, so off he goes. I see four more patients. 4pm: Knock on door, healthcare assistant, can I review a wound on a patient. 4:11pm: Knock on the door from the practice manager. We had a visiting clinical pharmacist, they have done 29 patient reviews, someone needs to review each case with her and prescribe the medications. The allocated staff member is not available. I do this while patients are waiting. 5:30pm: See a patient with a severe mental health crisis. Mental health takes up at least 30% of my appointments. Support services for mental health are diabolical so these patients come in week after week for support. We try different medications, we talk, we listen, we counsel but we are not mental health experts. At times amid the repeat visitor whom we know well there will be one who is more depressed than usual, we detect a change in their usual demeanour, does this mean today might be the day that suicidal thoughts turn to plans which turn to action? 5.45pm: Drinking a can of Coke on route to a home visit for another end-of-life patient. She is dying in bed at home. 7.30pm: I turn the computer off for the day. Today is August so this is a ‘quiet’ Monday. Time for bed, all to be repeated tomorrow. *Dr Keith works with the Rebuild General Practice campaign group. This diary has been edited down and does not include all the tasks she completed that day.