News from the front line: adventures in general practice

June 30, 2015 in laravili

Dr Lara Vili (pseudonym) is a salaried GP working in North West England. The views expressed in this Blog are her own.
Ch-ch-changes… turn and face the storm (with apologies to Bowie)
Whoever said a change was as good as a rest never worked on the NHS frontline.
Three years ago I joined a practice that doubled as a Walk-in centre for unregistered patients and catered for all comers 12 hours a day, 7 days a week, 365 days of the year.
In my younger days I’d wanted to be a trauma surgeon – life and family intervened and I became a GP with a special interest in Urgent Care. I had worked in Accident and Emergency as a GP before all the brouhaha of the “4 hour target” and the development of Urgent Care or Walk-In Centres, so this seemed like a logical progression.
My teammates and organisation were as keen as I to develop the practice as a training environment and I had visions of developing a new kind of GP training placement that gave trainees what they would need in the future 24/7 NHS that, yes, even then seemed on the cards. The Deanery, always progressive when it came to widening exposure to general practice for all doctors to be, was supportive and we were given the green light.
Fast forward those 3 years and I am on the verge of changing practices again, this time to one with no Out of Hours, no weekends and, most importantly, no Walk-ins. One that even – for now – isn’t a training environment. Why?
There are many factors involved but a major one is the sheer volume of workload. When you are on duty, you are full-on the whole shift and whilst this is always a mixture of surgeries for registered patients and walk-ins, it’s the latter that wore me down.
The numbers attending can make you feel you are under siege, especially with the level of verbal abuse the public seem to feel is acceptable and allowed when dealing with healthcare professionals who, at the end of it all, are trying to help them. I’ve been cursed, spat and lunged at but, unlike some of my colleagues, those blows never connected.
It isn’t just the behaviour though, it’s also what people feel is appropriate to present with. I have always made it a point to ask the “why here, why now?” question of attendees, and whilst a fair number say they couldn’t get an appointment with their own GP soon enough, or to fit in with their job, I’ve also had some unexpected responses.
“I was on my way home from Shopping, so thought I’d pop in” is common. “I was on my way to the pub (sometimes between pubs) and thought I’d come and get my (decades long) problem sorted out” is less so but still frequent.
All walk-in patients seem surprised that I can neither access their GP records or hospital notes, so I can tell them what their test result is or give them a script for their repeat medications. Even more likely to generate discontent are the facts that I can neither book investigations for them, or refer them for non-urgent hospital care.
It’s not all bad. I’ve – literally – saved lives with my hardworking, hard-pressed team and have had thanks and hugs on occasion. And those teammates, along with quite a few of my ‘regular’ patients are what I will miss.
Next week I start in an urban practice that has struggled to recruit a partner simply because of where it is; not leafy suburb, not high-end property values. I am really, really, excited to be joining them.
I’m not expecting it to be easy; general practice, when done well is not easy. But what I know I won’t be doing is weekends, late nights or Bank Holidays.
So, back to Bowie. I faced the storm of Cameron’s 7 day a week access to general practice and, can honestly say that it doesn’t do what it says on the tin. It provides a good stable-mate to over-pressed Accident and Emergency departments and deals with urgent minor illness very well. But in my experience, when offered a 7 day general practice service that’s not what the public wants. They want the whole nine yards of treatment, investigations, results and referral and for that, the seamless NHS-wide IT system that has been touted for over a decade must be in place.
Oh, and of course, the staff to work in that system. I won’t be one of them.
I’m hoping that this change will be a rest.

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