“I work as a GP partner in a large practice of nearly 30,000 patients in east Bristol. We are also a training practice with a steady flow of GP trainees and I am one of three trainers here. We have a large cohort of GPs and serve a varied population of young families, elderly housebound patients and university students. It is a buzzing and fast-paced environment.
I feel very privileged that I can play a part in training the next generation of GPs. I remain very conscious of the need to be positive about the pivotal nature of our roles as family doctors and gatekeepers to the NHS, while at the same time being realistic.
A working day can easily extend to 12 or 13 hours. I am a part-time GP but my hours are near full-time when training, supervision and partnership duties are factored in. It is the toughest and most time-pressured job I have ever done. There is no end point to the work and medical complexity continues to rise and can be hard to fit into 10- or 15-minute slots.
Thanks to the rise in allied professionals such as pharmacists and physiotherapists working in general practice, the cohort of patients that we GPs are seeing is changing to those with mental health problems and multi and complex morbidity. Telephone appointments do not always take less time and sometimes there is a back and forth of us trying to get hold of patients.
This is often encroaching on time GPs have for family, exercise and social activities. On some days I can feel ‘talked out’, with little energy to engage in conversations with my husband or the children. My husband works in the NHS and understands the pressures. My older two kids, who are twins, join medical school this month and I worry what the future NHS will look like for this next generation.
Often it feels like all roads lead to general practice, with often inappropriate passing of work to us. ‘Get a note from your doctor’ is a common thing I hear most days at work.
With the Covid backlog in hospitals and a national drive for reducing referrals, GPs are seeing more complex patients in primary care. There is also increased hospital correspondence such as emails that we write for advice and guidance from specialists. There are medical reports, repeat prescription requests and blood results to review – what I call ‘unseen work’. Much of this paperwork is done late into the evening or remotely on days off. At the same time, patients who really need to see a doctor worry about bothering their GP. Balancing the risk and uncertainty of who needs more input can be challenging and draining.
In the current environment being a GP is becoming an almost impossible job to do well.
GP training pathways are protected in terms of hours and sessions worked, which is a good thing for their learning, experience and progression. The number of face-to-face patients, contacts and admin workload is set in a way to develop and challenge but not overwhelm them. But they remain aware of how big a chunk of a GP’s day consists of this ‘unseen work’.
Just as many GPs have moved to part-time working or developing portfolio careers, so too are GP trainees, either during their training or as newly qualified GPs, as the King’s Fund research shows. This is a response to the state of general practice. The toll on doctors’ wellbeing in recent years has been huge. We have no control over the diktats that come from the government, which seem to show little understanding of general practice workload, the wellbeing of its staff or that NHS IT and buildings infrastructure are so inadequate.
There is a big drive to expand GP training programmes to increase the workforce. But recruitment alone is not the answer. Unless the state of general practice is to change, where it becomes better resourced, boundaried and less politically driven, then the numbers of GPs out there will never equate to whole-time equivalents. If we want to attract the next generation of junior doctors into what can be one of the best jobs in the world then this change needs to happen now.
We need more staff. But the government needs to support practices to increase building capacity to make room for staff, as this hasn’t kept pace with expanding practices and list size. And ministers should also consider the impact of their changes such as evening and weekend working as existing staff cannot be stretched any more.
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