7.30am – 8.15am
My day starts with 45 minutes of paperwork: looking through correspondence, discharge summaries, out-of-hours reports and test results. Many of the hospital letters request specific GP actions, such as forwarding the results of previous investigations or arranging further tests.
8.15am – 9.00am
I spend 45 minutes taking telephone triage calls for people requesting same-day appointments.
The 10 phone calls cover wide-ranging problems: many relate to respiratory infections; some are requests for home visits; others are chasing test results. One in particular stands out: a patient’s husband calls about his wife who was physically and verbally abusive to him the previous night. She doesn’t know that he has called me, so I have to work through the ethical issues that this presents.
9.00am – 1.00pm
A total of 18 patients are booked into my morning surgery; the first patient arrives at 9.00am, and the surgery runs right through until 12.30pm. Between seeing my own patients I am called in to review others with my new GP trainee, who has just started consulting.
The most unwell patient of the morning is a pregnant woman with poorly controlled diabetes, who has what appears to be pneumonia. She is breathless and clearly unwell with low oxygen levels. She struggles into the surgery with her young 18-month-old child. She asks me to take a look at her son, who is not booked in for an appointment – he is breathless and wheezy and needs urgent treatment with a nebuliser. Once his breathing has stabilised we arrange for his father to come and collect him from the surgery. I then contact the medical registrar at the hospital to arrange an emergency admission for his mother; I have to wait for him to call me back to discuss the referral as he is busy treating an acutely unwell patient and there is no one available to take the message.
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; this adds another layer of complexity to the consultation, and makes it much harder to build a good rapport.
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 (we are having difficulty filling a practice nurse vacancy) 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 quickly move on to my lunchtime home visits. I have two visits booked in. The first was requested by the wife of an older housebound patient who is concerned that her husband has been confused and lethargic over the past few days. As I head out, the receptionist informs me the visit is no longer necessary as he was rushed to hospital that morning with suspected urinary sepsis following acute deterioration overnight.
I go straight to the second visit; this older patient has been feeling dizzy when she stands up. On checking her blood pressure, I notice that it 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 – used to treat high blood pressure – and arrange a follow-up home visit in a week.
1.45pm – 2.15pm
I return to the surgery and sit down with my trainee to discuss the patients from her morning surgery and home visits, to ensure she made appropriate clinical decisions.
2.15pm – 3.00pm
I take stock of what I need to do 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.
3.00pm – 3.30pm
At 3.00pm I return phone calls to patients who called that morning. Among the 10 calls there are more respiratory infections, two cases of mild food poisoning, a hospital doctor wanting to know a patient’s detailed medical history, and the Coroner querying a death certificate I completed the previous week.
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.
3.30pm – 5.30pm
There are 12 patients booked into the afternoon surgery. I have quite a number of patients with mental health problems in to see me. 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.
5.30pm – 6.30pm
After the clinic there are another 12 phone calls to make. 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 from patients. I speak to a concerned man who has an enlarging aortic aneurysm – a dangerous swelling of the main blood vessel leading away from the heart. He had been admitted to hospital that morning for elective surgery to repair the aneurysm, but his operation was cancelled due to an emergency patient needing surgery. He was promised a new date but has since been told it is unlikely that a bed can be found for him this week.
6.30pm – 7.00pm
I sit down with my trainee to discuss the patients from her afternoon surgery. I am impressed by how independently she dealt with a number of complex patients. 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).
End of the day
On my way home I reflect on the list of things I have left un-done.
The issue of our unfilled practice nurse vacancy is no further on; an outstanding audit for the CCG on A&E discharge summaries has been neglected for another day despite the looming deadline; there are new referrals to be made, old referrals to chase and medication queries to be resolved – the list goes on.
At least some of it can wait until Saturday.