A day in the life of a GP
As doctors, it may be viewed that we work fixed hours, according to the opening times of the surgery, however this is far from true. Patients may perceive that the day starts at 8.15am when the appointments line opens and finishes at 6.30pm when the doors are locked. The practice thought it may be helpful for patients to gain some insight into the current workload of a GP.
Dependant on workload your GP may arrive in the surgery to start work at 7am or 8am and will not go home until 8 to 9pm. This is a 12 hour day. Unfortunately doctors cannot be available for appointments for all of this time owing to the associated paperwork and other requests from patients and the Department of Health.
We give an example of a possible day for one Doctor below:
18 actual morning appointments at 10 minutes each. Starting at 8am. He is scheduled to finish at 11.00
By 10am he is running 20 minutes late for his patients who have actual timed appointments, this is because he had to admit one to hospital and received a call in between seeing patients from a District Nurse needing immediate advice regarding a palliative patient at home.
He has 5 emergencies added on who have called before 11am (they are all told to present at 10.30am as this doctor advises his emergencies to arrive towards the end of his surgery but before his cut off time. He will then fit those extra patients in around his patients who have actual appointment times.
Based on the fact he is running 20 minutes late for his normal appointments he is then already at 11.20am when he starts to see the 5 emergencies waiting. He would have seen them earlier but he could not predict running 20 minutes late as it is impossible to predict patient need. The emergencies take 25 minutes and so his morning surgery seeing patients finally ends at 11.45am. His emergencies have been given a leaflet explaining that as it is not an actual appointment, they are being squeezed into a fully booked surgery and that we aim to keep the wait to below 2 hours.
Emergency slots are designed to ensure our patients are offered same day access to a GP even when the doctors have no actual appointments left and a patient has a medical problem that cannot wait. We cannot offer a choice of Doctor, fit it around someone’s schedule or hurry a Doctor. If the matter is urgent we would expect patients to wait and be seen when the GP has made time or if they are not prepared to wait then we would expect patients to re-book into a routine appointment as it is then apparent that the matter is not urgent as it can wait for another day.
At 11.45am the Doctor has a 30 minute medical examination booked in and so he completes this. At 12.20pm he signs his prescriptions, reads 30-40 hospital letters, dictates any referrals, completes any actions and change of medication requests. He reads approximately 30 Pathology and Radiology results and marks them normal, abnormal etc. and advises Administrators of those patients that need to be contacted.
This takes him until 1.30pm. On this day he has no visit requests, however there are occasions’ where the Doctor needs to go out at this point in the day to see a housebound patient who has an acute need or he needs to certify a death. At 1.30pm he reads all of his messages from Reception and actions them, this can take half an hour.
At 2pm he commences afternoon surgery seeing patients with actual appointment times at 10 minutes each until 5pm. At 2 pm he already had 2 emergencies added on who had called after 11am to find he was fully booked, they will be arriving at 4.30pm. This Doctor asks for all of his emergency extras to arrive towards the end of his surgery at 4.30pm to wait and be fitted in (some ask for patients to arrive at the beginning of their surgery at 1.30pm). By 3.30pm he has another 5 emergencies added on. He is running to time in his afternoon surgery and so starts to see his 7 emergency extras at 5pm. He finishes seeing patients at 5.40pm. The cut off time for booking into afternoon surgeries is 5pm otherwise Doctors would continue seeing patients late into the evening. Any medical emergency after 5pm is referred to the duty doctor of the day and after 6.30pm to the 111 service or other appropriate emergency service.
At 5.40pm this Doctor has a home visit to do and so he leaves the building to see the housebound patient. He returns at 6.10pm. He completes his afternoon prescriptions, letters and messages. The doors close at 6.30pm. He completes any private requests for insurance reports or other reports requested by other authorities. He finishes at approximately 8pm and goes home. Where doctors run late in afternoon surgery we continue to see those patients already booked in even if they have not been called by 6.30pm.
A full time Doctor in the surgery works approximately 60 hours a week.
All doctors take it in turns to be duty doctor for the day
The duty doctor on call for the day, starts work at 7.45am, taking any emergency calls that are put through from the out of hours service. Any queries (of which there are many) are dealt with both before, during and after morning surgery. The morning surgery typically lasts for 3 hours depending on how many "extras" are slotted in and following that, the morning post will have to be dealt with. This involves reading and "actioning" anything up to 50 letters that have come from the hospital or from patients. There will then be visits to attend to, prescriptions to raise and sign, pathology results to read, and then referrals to dictate. During this time there will of course be any number of queries put through from reception, whether it is phone calls from patients, from colleagues at the hospital or urgent blood results from the pathology lab.
The afternoon surgery will then last 2-3 hours depending on how many "extras" are slotted in. The repeat medication queries will be dealt with, prescriptions signed, queries from reception and finally the door of the building will be locked for another day. Now it is time for paperwork, which typically takes another 2 hours, including medical reports from occupational health departments, life insurance companies, any other home visit requests, QOF targets, QP targets to be met etc. Home time at last, and the GP may finish work around 8-9pm. Once home, somewhere in that hectic schedue the GP has to find time for fulfilling their independant learning, of which there are increasingly significant requirements for appraisal and revalidation.
The duty doctor for the day has extra responsibility after 11am and 5pm. The other doctors in surgery that day also work the same hours.
Reasons why your doctor may run late
It is inevitable that sometimes your doctor may run late. We are sorry if you are kept waiting longer than you would expect. Here are just a few examples as to why your doctor may run late in surgery:-
- Your doctor is duty doctor for the day and has been called to an emergency
- Your doctor may be admitting someone to hospital-this can be a lengthy process
- They are required to take a call from a colleague at the hospital in relation to a patient
- A patient is presenting with more than one problem on a single appointment
- They have been interrupted between patients to deal with an urgent request for a prescription or other matter
- They have been called out to confirm a death
We ask patients to please try and understand why we sometimes run over time. Doctors and nurses do try to see patients as close to their appointment time as possible. Every patient has different needs and we never know what type of problem or emergency will present.
Help us to help you! by planning ahead with regards to your repeat prescriptions and routine appointments.
Did you know ? GP's deal with 90% of the NHS workload with less than 10% of the NHS budget. Everyday in the UK, almost one million people visit their GP.