This article is an update of our original ‘a day in the life of a GP’, which drew on the experiences of GPs in different practices, and was published alongside out 2016 report Understanding pressures in general practice.
The text outside the boxes represents a typical day in the life of a GP. The text inside the boxes represents an alternative day in the life of a GP within an innovative model of general practice.
7.30am – 8.15am
My day starts with 45 minutes of paperwork: looking through correspondence, discharge summaries, out-of-hours reports and test results.
8.15am – 9.00am
I spend 45 minutes taking telephone triage calls for people requesting same-day appointments, requesting home visits or chasing test results.
8am – 8.30am
My day starts with a coffee and informal huddle with the members of my micro-team – nurse case manager, health care assistant and administrator. We talk about the patients due to be seen that day, any issues that came in yesterday from other health and care professionals or from patients via phone and email.
9.00am – 1.00pm
Morning surgery: a total of 18 patients are booked in; the first patient arrives at 9.00am. Between seeing my own patients I am called in to review others with my GP registrar. The most unwell patient of the morning is a pregnant woman with poorly controlled diabetes who has what appears to be pneumonia. She struggles in with her 18-month-old child, who is breathless and wheezy. He does not have an appointment but needs urgent treatment. Once his breathing has stabilised we arrange for his father to come and collect him. I then contact the hospital to arrange an emergency admission for his mother. By the time the patient is safely in an ambulance my morning surgery is running 40 minutes late. The patients who have been kept waiting are understandably unhappy.
8.30am – 12.30pm
I respond to messages from patients that only I can deal with. This includes responding to seven emails, phoning five patients and seeing eight patients face to face. Many more patients have contacted the surgery but have been dealt with by other members of the team, including the pharmacist and the paramedic practitioner. The patients I see in person have complex problems and on average have 15-20 minute appointments. For one of them I contact a local specialist using our electronic advice and guidance system and get a reply to my query within an hour. I phone the patient to adjust her medication.
I answer queries from other team members and provide support to my new GP registrar. I take one patient over to see the community link worker as they have issues with housing. For the unwell mother and child, the paramedic practitioner comes in to assess the child and stabilise his breathing. The administrator arranges for his father to come and collect him and contacts the hospital to arrange an emergency admission for his mother. The health care assistant sits with her and monitors her oxygen levels until the ambulance arrives. We have worked to develop clear protocols for arranging emergency admissions with our local hospital.
1.00pm – 1.45pm
I finish my delayed morning surgery at 1.00pm. We had planned a short practice meeting to discuss some staffing issues but three of the seven GP partners have emailed to say they can’t attend due to over-running clinics or home visits. The meeting is rearranged for an evening the following week. I move on to home visits. One visit is to an older patient who has been feeling dizzy when she stands up. Her blood pressure drops significantly when she stands. I review her long list of medications, and we agree to try cutting down the dose of one of her three anti-hypertensives and arrange a follow-up home visit in a week.
We have a team huddle to discuss any further actions from this morning’s surgery. We make a note to ask the behavioural health specialist to follow up with the mother on her discharge from hospital and the nurse notes she will call the father later to check how his son is doing and give him advice.
We eat lunch round our team table and are joined by the pharmacist, paramedic and midwife. Tomorrow we’ll go on our regular health walk with some of our patients, organised by the practice’s volunteers.
I don’t have any home visits scheduled today. Our paramedic heads out to visit an older patient who has been feeling dizzy when she stands up. Her blood pressure drops significantly when she stands. He calls the pharmacist at the practice to get advice on her long list of medications and they agree with the patient she should try cutting down the dose of one of her three anti-hypertensives. The health care assistant will call her in two days’ time to follow up.
1.45pm – 2.15pm
I sit down with my registrar for a brief supervision.
1.30pm to 2pm
I sit down with my registrar for a brief supervision.
2.15pm – 3.00pm
Before my afternoon surgery starts I have four referrals to write, 18 clinic letters to process, 28 prescriptions to sign and 36 lab results to check and action. I do this while eating lunch at my desk. One stool sample comes back with Shigella, a serious infectious disease that must be reported. The patient – a man in his 70s – has since been admitted to hospital. I get through to him on his mobile and find out the ward details in order to ensure the result reaches his clinicians.
2.00pm – 3.00pm
I have a conversation with the practice manager about the difficulties we’re having filling a practice nurse vacancy and we discuss some potential approaches which she’ll share on Wednesday at the weekly practice meeting. I deal with other emails from the CCG. I review five medication changes that the pharmacist has alerted me to and deal with a query from the health care assistant about a lab result that shows a patient, who has since been admitted to hospital, has Shigella. She talks to the clinicians on the ward to alert them.
I phone the consultant psychiatrist who works within our collaborative care model to discuss a patient I saw this morning and agree a plan. The administrator and I discuss the audit for the CCG on A&E discharge summaries.
3.00pm – 3.30pm
I phone patients who had called earlier, a hospital doctor wanting to know a patient’s detailed medical history, and the Coroner querying a death certificate I had completed. I also speak to a patient who is travelling to Oman and needs a letter for the airline as she is six months pregnant – her flight leaves that evening.
3.00pm – 3.30pm
I respond to three more emails from patients and phone two patients that the rest of the team can’t deal with. Our health care assistant speaks to a patient who is travelling to Oman and needs a letter for the airline as she is six months pregnant – her flight leaves that evening.
3.30pm – 5.30pm
Afternoon surgery: there are 12 patients booked in, many with mental health problems. One patient has had an 11-week admission to a private psychiatric hospital and is re-adjusting to life ‘back on the outside’. He is doing well. Another patient is a nanny who has an eating disorder; she forgot to feed the children she looks after as she is so preoccupied with her problems. We discuss her fitness to work. These patients definitely need longer than the 10 minutes they are booked in for.
3.30pm – 5.10pm
There are six patients booked in, several with mental health problems. One patient has had an 11-week admission to a private psychiatric hospital is doing well and is also being supported by the community link worker to find other sources of support. Another patient is a nanny with an eating disorder. We discuss her fitness to work and I take her over to see the behavioural health specialist. I find 20-minute appointments have helped me have time for these complex issues.
5.30pm – 6.30pm
After the clinic I make 12 more phone calls. I return a call from social services and another from a district nurse who is worried that a patient’s wound has become infected. The rest of the calls are with patients. I speak to a concerned man who had been admitted to hospital that morning for elective surgery to repair an enlarging aortic aneurysm, but his operation was cancelled.
5.10pm - 5.45pm
I deal with a few more queries from the team. Before leaving I have a quick look at what is booked in for tomorrow morning and make a note to remind me to ask our administrator to follow up with a man who has had his elective surgery cancelled.
I head home and it’s my turn to bath and put my daughter to bed.
6.30pm – 7.00pm
I sit down with my registrar to discuss the patients from her afternoon surgery. We squeeze in some brief teaching on the treatment options for migraine.
7.00pm – 7.45pm
After completing two more referrals and dealing with some medication queries, I finally get round to dealing with my 43 emails. Most are related to management of the practice or my work for the clinical commissioning group (CCG).
On my way home I reflect on the list of things I have left un-done.