I work as a 5 session GP partner in a busy market town practice. Our practice looks after 16,000 patients and is split across 2 sites. The main site looks after 12,000 patients and is in the middle of a market town, the second site is a rural practice looking after 4,000 patients. Our medical work force at the market town practice is made up of 5 partners and 3 associates, all doing a varying number of sessions. At this site we have just over 4 whole time equivalent partners and 2 whole time equivalent associates.
I work Tuesday all day, Thursday morning and Friday all day. However, there are many partnership commitments that require me to attend daytime, weekend or evening meetings outside these hours, therefore, a snapshot of a day in the life of a partner is not truly representative.
While the primary focus of a partner’s work is providing good clinical care for their patients their breadth of responsibility extends far beyond this. As a partner I am involved in decisions affecting all aspects of practice ranging from staff employment, contracts, financial decisions, budget setting, premises development and modification, staff development, appraisals, grievances, general practice politics, practice based commissioning, commissioning consortia, developing income streams, managing QUOF, writing and implementing practice policies etc, etc. While this level of responsibility and commitment is extremely time consuming it is also extremely enjoyable and rewarding as one is part of the team who makes decisions about exactly how we work and how our practice is run.
I have outlined my experience of a typical Tuesday at work:
0800 Arrive, say hello to our reception staff and secretaries, go in to my consulting room, I usually have to tidy it up as others have used it the day before when I am not in the practice. I log in to the computer and check the requests for phone calls and visits that have accumulated from the day before when I am not at work. I then briefly look over my morning surgery and check my emails. I nip upstairs and make a cup of tea and then start surgery at 8.30 am. Occasionally I have booked in a patient at 8.15 or 8.20 if I am short of appointments or if they need longer or are unable to leave work easily. My surgery runs from 8.30 am until 11 am after which there are booked extra patients, usually between 4 and 6 which means I tend to finish morning surgery at around 12 noon – 12.15 pm. I see a wide range of clinical cases and the most noticeable difference from working as a locum as I did many years ago is that I know the patients extremely well. Many of them I have looked after for the past 14 years and the benefit of this cannot be underestimated both in terms of the rewarding relationship one builds up and the ease of understanding their current presentation in the context of their past history. I thoroughly this level of continuity of care and feel it also benefits the patient greatly, not just in terms of knowing their GP well, but also I believe makes for better and safer medicine.
Throughout the morning surgery I receive various turbo notes requesting I make urgent phone calls to various people and on 3 occasions when I am leaving my room to greet the next patient I find people waiting to ask for my advice either dispensers or nurses or reception staff. These interruptions can be very frustrating and often result in me running behind which I find uncomfortable.
Throughout my morning surgery I am also keeping an eye on my list of phone calls and visits which is on a different screen and wherever possible I try and return calls as quickly as I can to keep on top of the workload. During this specific morning surgery I had to admit 2 patients and this always takes longer, usually 20 minutes to ½ hour so I was running quite late and finished at 12.20 pm. After this I continued to return phone calls and started to look at my post.
1300 Partners management meeting, this is attended by all the partners from both surgery sites and our practice manager. Our meetings usually last between 1 ½ - 1 ¾ hours and are held on most days of the week except Monday. This meeting was devoted to looking at management issues in practice as we have just appointed a new practice manager and the agenda included such items as reviewing practice security, associates contracts, staff issues, standards of cleaning in the practice, arrangements for the Christmas party, agenda items for a partners and associates meeting on the Thursday which I am chairing. This meeting ran on until 3 pm.
1500 At this point I had ½ hour before my afternoon surgery starts which runs until 5.30 pm with booked extras and had intended to continue with my file and start looking at my blood results and catch up with further phone calls that have come in. However, a patient at reception had requested that he be seen urgently, his wife who I was looking after had just died from lung cancer and while I was ushering him in to my room I had to take an urgent phone call from a worried mum of a 5 month old baby who was vomiting persistently and crying. I asked her to come down to the surgery immediately, so as a result I started surgery approximately 10 minutes late. I managed to catch up this time through the afternoon surgery and then had 2 extras at the end. I then finished at approximately 5.50 pm.
1750 I now had 40 minutes until my extended hour surgery begins at 6.30 pm. During this time I managed to complete my post, look through my blood results, phone 2 patients who required prescriptions for confirmed UTIs and dictate 2 letters from my dictation list.
1830 I started extended hours with a further 6 patients. I actually enjoy these surgeries as the phones are switched across to the Out of Hours service so I am usually undisturbed during this time and can relax and talk to patients without interruptions in the knowledge that there will be nothing further coming through on my phone or visit list. The last 2 patients took slightly longer than expected as they both had mental health issues and at 1955 hours I closed down the computer having already said goodbye to the staff who had left prior to me and hello to the cleaning staff who had just arrived.
I then returned home. At home I am aware that I am chairing a sensitive meeting on Thursday and start to read the previous minutes and start to think how I will approach this.
These are extremely long days after which I always feel extremely tired.
Putting this in to the context of my working week. I do not work in the practice on a Monday but on Monday evenings once a month we hold our partners meeting in a private room at a local restaurant which runs between 7.30 and 10 pm.
On Thursday after I have finished my morning’s work there is a partners meeting which usually runs until 2.30 or 3 pm, after which I usually take the opportunity of using the remainder of my half day to catch up on my paperwork, PMA reports, important partnership discussions, letters etc.
Friday at lunchtime we always have an education meeting.
As partners we are responsible for providing flu clinics which run on a Saturday and recently when we were interviewing for our new practice manager we were responsible for reading and prioritising over 100 CVs and met frequently in the evenings and weekends to enable us protected time to focus on our decisions.
Partnership offers a wonderful chance to be involved in the development and running of a practice. It is extremely rewarding but extremely demanding, but on balance I find positives though challenging far outweigh the negatives.
JH
GP Tutor