Before the clock hits 8.30am, Dr Paul Evans has already put the mind of an older man concerned about lesions on his back at rest. He's not got cancer, and can be on his way. "Nothing to worry about."
Along with his colleagues at the Bridges Medical Practice in the heart of Gateshead town centre - it's situated literally below Tesco - Dr Evans is seeing more patients than ever. And on a busy May Monday, he invited ChronicleLive to spend the day watching exactly what happens in a GPs' surgery in 2022.
Previously, the medic has been vocal about the pressures general practice is under - with changes to contracts afoot and the profession consistently calling for the Government to do more to train up more GPs and deal with the challenges like a high burnout rate.
Read more: Covid-19 'definitely not going away' warns Gateshead GP
By the end of the day around 45 people will have had appointments with Dr Evans, and well over a hundred more may have had a prescription signed off or test results analysed by just one doctor. And colleagues like Dr Dawn Turner and nurse practitioner Kerry Barnett have similar workloads. The British Medical Association recently found the profession has lost almost the equivalent of almost 2,000 full-time doctors since 2015.
But at the front desk in Gateshead, admin team members - known more accurately as "care navigators" - like Kimberley Quinn and Sam Annison spend their days busily making sure worried parents can get appointments for their children and helping patients see the right person. Their phones barely stop ringing. This is what going to the doctors in 2022 looks like.
A day in the life
Dr Evans is both the partner at the practice and a senior local figure, heading up the Gateshead and South Tyneside Local Medical Committee. During a busy day he sees patients from all walks of life - an early start sees a woman he knows well attend with a skin complaint. She's had an issue before, and the doctor is concerned it's come back.
Within minutes - along with the medical student he's helping to train, Dr Evans has had a close look, and a feel, of a suspicious wart. Not satisfied, this patient is rapidly referred off to dermatology at the RVI. It's still before 9.30 and the doctor's coffee has gone cold. Next up, a mental health patient who is concerned about side-effects from his new medication. It's still early days, and Dr Evans persuades him to stick with the regime for a week. But he's going to keep a close eye. "How does a similar time next week sound? I'll give you call."
Next up there's a junior doctor with a stomach complaint - though the doctor takes the time to check up on his asthma too. Then in comes a teacher with a cough and tales of how, in the last few days his energy has disappeared. He tells Dr Evans it's not Covid. After a bit of a chat though, it becomes clear that, yes, it is.
There's a child with 'hand, foot and mouth'. Though mum looks worried for a second when Dr Evans explains "if there wasn't an outbreak at nursery, there is now", all is well as he reassuringly adds: "It's a mix of very infectious but luckily absolutely harmless!"
But more complex cases present themselves too. One particularly concerning mental health patient calls up early in the afternoon. His issue is around the medication he's taking to treat anxiety and depression - and he explained over the phone that traumatic life circumstances had led to the pressure rising on him once again. Another case sees a younger man who's previously suffered with addiction attend to discuss medication.
Dr Evans explained that the biggest issue facing general practice is rising demand - combined with the burnout and fatigue already hard-pressed medics are facing. "What's going to be our big challenge in the next few years is development. There are to be hundreds of new flats down on the riverside, and we're the nearest practice.
"A substantial part of my day is scans and 'scrips. It's a lot of work that goes unseen, but I'm here 'til around 7.30. There's more patients, more calls. Demand is what it is." His colleague Dr Turner added: "I'm starting earlier and finishing later. We are seeing more patients in clinic than we used to - on average it must be about a ten-hour day, but I know colleagues can end up doing more."
Despite the pressures faced by each of the staff members at the Bridges, they spring into action rapidly when potentially frightening situations occur. On this Monday afternoon, a worrying phone call arrived from the mum of a child who's recently had a serious infection and is again showing signs of illness - vomiting and rashes.
The reception staff relay the information to Dr Evans - and he's in no doubt, this mum needs to get her little boy down to the surgery as soon as possible. Within an hour or so of calling up, the family are in the consulting room and Dr Evans is visibly relieved at the boy's state. He's unwell, but things aren't as scary as they could have been. Moments later, he's explained that the issue is "a touch of pneumonia". The little boy should be fine after a few days on an antibiotic.
But it's not just doctors
In the next room sits Kerry Barnett - a nurse practitioner. Kerry has a special interest in women's health, the menopause and HRT - but she is also qualified to treat patients in a very similar way to the GPs. Though she'll pass more complex cases or those outside of her expertise on to others, she takes on everyone from those with tummy aches to women needing contraception advice.
"It can be so difficult to run to time," she explained. "People think that the time they see the doctor is all that there is, but there's all of the before - the reading of their notes, refreshing your knowledge of their issue - and then writing things up after. The five or ten minutes a patient is in the room for is far from the whole story."
It's early afternoon and a young woman comes in with a sore stomach. Within minutes Kerry has had "little bit of a feel" and spoken with her about keeping a food diary and potential medication. Then it's time for a quick phone call - an 18-year-old is keen to talk about if the "mini-pill" is the right contraceptive for her, and then a man requiring a Farsi translator arrives in the consulting room.
It's a hard to understand case complicated by the language barrier. But using a telephone translation service, Kerry is able to reassure the patient about his heart concerns and his cough - though, the added time taken by the translator means the appointment runs over. Then Kerry makes another phone call - but not for the first time she gets no answer from the patient. "That's 50 minutes lost to DNAs already today", she said. "Nearly an hour lost."
One way in which the pandemic and its aftermath has had an impact on general practice, Kerry explains, is to do with the way long waiting times - both in A&E and for treatment in hospitals - are making more work for doctors and nurses in the community. She said: "Someone might have been to the hospital, started on a treatment pathway, and then they leave and try to come to the GPs'."
She also explained how the longer someone is unwell or waiting for treatment, the more GP staff were having to see them each day. Within minutes though, she's caring for a worried young woman with bladder problem, followed by someone struggling with the impact of migraines on her home life - complicated by illness in the family.
That case is, happily, one where a change in contraception might help. Kerry added: "It's really just lovely to when there are patients coming in who we can actually help - where can genuinely do something for them that's going to make a difference."
Kerry also works at a practice in County Durham, and she said one of the big challenges for general practice was that patients often expected an outdated idea of what their doctors' surgery looked like.
Phone or face to face?
Throughout a busy day, the front-of-house phones keep buzzing while the doctors and nurses are continually calling patients back. Since the pandemic hit, a big NHS talking point has been around whether or not patients can see their family doctor in person. At the Bridges, this has always been possible, though the team there explained that at the height of Covid-19 more care was taken over if this was necessary.
Now, though Covid remains an issue seen on a day-to-day basis at the practice, the system is settling into a post-pandemic hybrid - some consultations are on the phone, but staff aren't shy of encouraging patients to come in for a face-to-face chat, and if that's what a patient wants, they'll be able to get that.
"It's about getting the balance right," Dr Evans said. He explained that now, more often that not, first appointments would happen in person. He added: "The vast majority of the time the answer is I need to see them. But a lot of follow-ups will be on the phone, and some people prefer that."
Nurse practitioner Kerry added: "Actually, so much can be dealt with over the phone. And some people prefer that." She said the flexibility of, for example, not having to take a morning off work suited many people. "But if someone is calling back with the same issue a few times in a row," she added. "You know you need to get someone in to have a look. Clearly something is being missed - whether in what they're saying to you, or what they want or what their issue is."
The Government has promised it is "committed to growing the general practice workforce" and has said We are committed to growing the general practice workforce". It has said there has been an increase of more than 1,600 GPs over the past two years, and added £520 million had been available to improve access and expand general practice capacity during the pandemic.
There was £1.5bn announced in 2020 which the Government said would create "an additional 50 million general practice appointments by 2024 by increasing and diversifying the workforce".
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