GPs in crisis

Doctors around the country share their stories about the day-to-day challenges of working in general practice

British Medical Association
2016

Gerry McCabe is a former GP partner from Hertford. After 15 years, at the age of 45, he resigned from his partnership due to an unsustainable workload.

When I became a GP partner in Hertford in 2000, a typical working day was manageable and enjoyable.

Our practice would see patients from 8.30am to 5.30pm; we’d have an average of 30 face-to-face consultations with far more time to care for patients; we’d have between five and 10 GP phone calls a day, and we’d eat lunch with colleagues.

No matter how late I worked into the nights or weekends, I never seemed to catch up.

For the last few years, however, the pressure and workload have increased, both from patient contact and more significantly from behind-the-scenes paperwork.

This meant I was unable to complete one task before the next one was due, and no matter how late I worked into the nights or weekends, I never seemed to catch up.

I maintained this relentless pressure for four years until I recognised the early signs of burnout, and saw no alternative but to resign from my practice in order to restore my work-life balance.

I saw no alternative but to resign from my practice in order to restore my work-life balance.

Since then I have been enjoying working as a locum.

However, I shall shortly be moving permanently overseas as I see this as the best option for the remainder of my career in general practice.

Over one third of GP partners are considering closing their lists to safely manage workload, according to our survey

Helena McKeown is a GP partner in Wiltshire and mother to two daughters. Despite extending appointment times to 15 minutes, the demand at Helena’s practice still means GPs never have enough time for each patient's needs.

It’s 7am and I’m on my way to work.

On most mornings, our appointment list is full. When I am finished with one patient, another is ready to see me.

I start work earlier and finish later than required in order to extend my appointments from 10 minutes to 15, but it’s still difficult to do everything required in that time.

When I am finished with one patient, another is ready to see me

By 11am I’ve seen 11 patients, contacted specialists to discuss two complex cases, signed urgent prescriptions and examined blood results. I jump in my car to visit the local nursing home, and then a terminally ill patient.

By the time I get back, it is evening surgery, which I carry into extended hours.

It’s close to my kids’ bedtime and I just want to get home.

Last year one of my longstanding partners left to work in a rural practice where the workload was less stressful.

We advertised for a replacement partner, but due to recruitment issues in the local area, just one person applied.

They were the perfect applicant and we offered them the job, but sadly they declined in order to take a better-paid post.

We will have lost four out of seven GP partners in the past 18 months.

In the end, we offered the post to a GP trainee who only wanted to become a salaried GP rather than a partner due to the added pressures of running a practice.

Worryingly, over this coming year, three GPs will be retiring. That means we will have lost four out of seven partners in the past 18 months.

At the same time, we have a salaried doctor on long-term sick leave with an acute injury, and may soon face a situation where we don’t have enough doctors for the number of patients walking through the door.

Nearly 85% of GP practices in England report that excessive workload is preventing safe delivery of patient care

Ian Hume is a GP partner in Diss, Norfolk. Balancing his workload to better serve his patients is getting more difficult.

Arriving for an 8.30am start, I have a busy morning seeing between 18 and 24 patients, and I grab a coffee while looking over the requests for home visits with my colleagues. I often have an additional 10 phone consultations throughout the day as well.

Morning surgery finishes at 1pm, with afternoon surgery starting at 3pm.

This gives us two hours to do home visits, attend a nursing home and make telephone calls, leaving no leeway for complications or delays.

I start at 8.30am and finish at 8.30pm – another fairly typical 12-hour day

The patients I visit are all in their 80s and find communication difficult. This makes each appointment longer than the time available.

My visiting schedule quickly slips, and I have to grab lunch from the petrol station before returning to the surgery for my afternoon appointments.

I work from 3pm till 6pm, seeing another 15 patients in that time.

On average, paperwork takes about two hours a day, following up test results and checking new mail, dealing with tasks and messages.

I finish around 8.30pm — another fairly typical 12-hour day.

Our campaign, Urgent Prescription for General Practice, aims to shine a light on the issues facing GPs.

Follow the campaign on Facebook and Twitter using #GPincrisis

Read practical advice on how to manage your workload with our Quality First web portal

Credits

Digital content producer: Jackie Mehlmann-Wicks and Sarah Quinlan
Email editor: Lisa Hansson
Senior digital content producer: Karen Lobban
Senior media officer: Eloise Henderson
Senior production editor: Kelly Spring

With thanks to the GPs who contributed their stories.