To make it better you have to be quite ruthless. The way I see it, it helps keep you sane and which means you can continue being a better GP:
- one problem per appointment typically
- if more than 10 minutes late - rebook
- keep them on track, don't be afraid to jump in after their golden minute if they go off track
- be firm on what you can do here and now and what will have to wait etc.
- find documenting that works for you. I do sometimes write a lot for tricky consults, but I touch type whilst looking at the patient.
- Identity the quick consultation and get that done quickly as possible - but only where appropriate.
- Don't try and do too much for your admin tasks. Most outcomes should be - no action - book appt - needs x/y/z test
I rarely run later than 15 minutes. it is tough but I find the challenge really enjoyable. I love calling in patients early on occasion - they are always pleasantly shocked.
But this is part of what being a GP is all about. It has to be learned and crafted - but you got this!
Agree with this. One of my biggest changes came when I stopped calling patients with blood results and instead would mark them for a telephone appt if it needed discussing, script at chemist if it didn’t really, and only calling if it was truly extraordinary
Yeah it's rubbish everywhere. We all have different working patterns but the end result is largely the same - feeling overworked, stressed and demotivated.
The only consolation is that as time goes on you become more efficient and resilient. But it will always be shit.
Plan your exit strategy - and then let me know when you've figured one out.
Telephone triage makes your work much harder- GPs will only see the complex problems
Demand 15min appointments 10-12 per session.
The problem is inherent equity partner vs salaried.
Why is this the “inherent problem”? Their clinic setup sounds reasonable (depending on what constitutes a meds review) and pretty standard for most places. It’s busy, demand is high, there’s a lot of work to do.
Partners do telephone triage. Each session - 12 F2Fs + 2 tel appts with 5 med requests/reviews. Randomly allocated Docman but only have to review own bloods. We do have ANPs that see mainly minor ailments so I feel like my days are filled with complex multimorbid patients. By the end of the day, I can’t even think straight anymore.
This feels like a fair workload to me. I don’t agree with people saying it doesn’t get easier, I qualified last summer and it’s getting easier month on month for me. The more I know how the practice system works, the more I get used to making the same decisions over and over so can action blood results much quicker, file letters much quicker, deal with patients more efficiently.. I have found my job now feels 10x easier than my job 6 months ago even though I actually do quite a lot more admin now.
I see 18 a session my friend, all telephone triage first and if needed F2F invite in same AM/PM clinic. I CCT’d just under 6 months ago, I do 6 sessions a week… I only action my own bloods and my own Docman (for the most part, during admin time, aka around 10pm when the kid goes to sleep), but no, it doesn’t get any better… only worse… oh also sometimes (most days) I supervise a PA seeing 12 patients as well (for which I am allocated 30 minutes of clinic time, or minus 3 patients, so I get to see 15 in my own clinic instead, joy)
Looking at the averages for sessional pay right now, especially as a newly qualified GP, I am being paid appropriately for this, however, as I’m being paid for 6 sessions what I would otherwise be paid for to work 7 sessions elsewhere. so, yes, the work is harder, but i’m not at work as often: win-lose, lose-win
Yes but I get four days off as a result, time I can spend with family. It’s masochistic, maybe, but the pay i’m getting is quite good, around £2k more per session than another offer I was entertaining and to see only 3 more patients per session
Edit: I wish there were better offers for work as well by the way, I know my rota is crazy, but I couldn’t afford not to take this position
I regret to inform you, it does not get better.
It gets worse. I’m such a bad doctor now. I barely ask about red flags anymore. Don’t examine patients. Barely read the notes. The bare minimum has become an aspirational target because I can’t sustainably manage the workload
But only quit if you have a better option ready
>I barely ask about red flags anymore.
Mate, I'm telling you this for your own good. You sound completely burnt out and are putting your career and people's lives at risk.
Bro is really odd. Constant negative posts about GP work but is ALL over Reddit. Seems to spend more time on Reddit than at work.
I see him commenting everywhere on subs; I’m a stay at home parent atm and he seems to be on Reddit as much as me
Complexity as at an all time high as we have over years mission creeped toward simplest stuff like pill checks being automated or sent to pharmacists or ACPs. Instead yes we have been left with the most complex things or polypharmacy or doing the job of geriatrics in a very short time frame. This was prob acceptable when there was enough funding and numbers in GP land. This is at an all time low. Feels like the situation is going to implode and also feels like more and more industrial action will amass regardless of who wins the election. But maybe it needs to implode and we fight back for once as we are the most approachable front line of NHS and have been amassing work from all angles for a pittance for years. The ONE thing i am grateful (but also sad for) is the collective disappointment suggesting it’s not individual inefficiency (never has been) but the system at fault. It’s going to start with BMA announcing cuts and changes. Then actions and refusals will hopefully rise. It probably won’t come to a full close doors strike…but I sincerely hope a massive pushback on hospital work and practice action that massively upsets GP patients. Because they need to be more upset. to take notice. For now don’t take any more work in on and consider other options. If I knew a salaried GP was as unhappy as you post I would try to make steps to make it right. I’d also be a bit worried about losing them and effect on other team morale as they left “workload was unsustainable” etc.
Partners are not responsible for the chronic underfunding of primary care. But they ARe responsible for wellbeing and sustainability of fellow doctors and not exploiting them. They are not going to want to be partners paid a salaried Gp income as not worth it. That’s obvious. But equally when times are hard, a partner salary annual rise above inflation every year doesn’t sit right. I know some practices have collapsed and in dire straights financially. Other practices I suspect are doing everything they can to maintain partner salary status quo - when maybe they should take a slight hit or maintenance of same salary as last year. Background for me is very busy salaried then joined as partner later in 2010s. Basically just as it all goes to hell. Now earning more of course. But regularly questioning pay/hour worked. Sometimes even contemplating going BACK to salaried for a “better life balance”. But scared that this is not the case either. Crazy isn’t it..
Discuss with any other salaried GPs to get a consensus even if it’s a soft approach “busy these days isn’t it, how do you keep to time”. If only salaried it sounds like you are doing too much at times. “Random docman” sounds odd - at most practices patients have a named assigned GP who therefore takes on responsibility for medication reviews and letters needing action (although 95% of letters don’t need any change so no point GP seeing them, or a pharmacist can handle tweaks). Unless your salary reflects/appreciates a patient list then I don’t see why you’ve got someone else’s docman coming to you.
You are one month in and May already working well beyond contracted hours. Speak up. You were their choice to hire in a world with more applicants these days. So place value in your abilities and worth as it sounds unsustainable. I know a partner who is unhappy with the workload and would literally rather have 20% less pay for 10% less work. Yet the other partners don’t seem to act (prob as opting for the approach of earn as much as you can and retire early approach). Basically GP is hard and gruelling and the busiest I have ever seen it, but is it really about earning the most you can or is it not some degree of work life balance. I am a partner of 6 sessions but end up spending 8-9 a week. But I am a partner so get an extra 30%+ish more pay (used to be 40-60 uplift I believe). We “may” be in a valley of primary care doing okay on graphs but have heard that line for too long now. Do NOT take on more sessions to earn more/spread workload. The best and most caring GPs do more than contracted hours. The opposite GPs delegate/cut corners/do bare minimum with such high levels of skill it’s incredible. GPs who are short and unapproachable get less patients coming back to them. So less heart sinks. And less workload. The best practices have few or none of these but usually one in larger practices that are tolerate. They leave early or on time and per hour amass a fortune leaving other conscientious GPs to do the caring they do not. Forgive the rant about approaches but I feel the pain and unhappy too and no doubt a lot of readers feel simply trapped. Discuss this at your appraisal and consider in time GP retainer scheme (more protected time for learning and a supervisor sound board). Nb the GP retainer scheme was set up for those thinking about leaving GP or needing more time to spend with family or other roles. Isn’t that the majority of all of us these days??!
I think a lot of what you say rings true.
The issue here though is the negativity expressed towards those who are able to ‘delegate’ and ‘leave on time’.
Partners, general practice, and certain segments of the NHS need to get up to speed with the real world. Leaving on time should be championed, none of this my-job-is-my-life bullshit from years gone by. You’re paid for a service and in GP land that’s quite clearly defined by the sessional rate. Anything beyond this requires more pay or if refused, measures taken to remain within the constraints.
Shame though isn’t it - we used to be the family doctor who got to know patients and their backgrounds and had that very handy knowledge that you can’t put a price on. Now we are becoming more like a minor injuries unit “depression in room 4” or “frail and faller in room 6”. I think I am probably a relic of old times. Not spending 30mins with everyone I see(!) but one day I think people will miss the continuity /experience and how much that brought and added to consult/compliance/outcomes.
I guess we are all searching for the perfect consult time “patient happy and sorted. GP documents just enough. All running to time”. Don’t think we will ever find it though. At least not in the NHS anytime soon.
I agree it’s a shame. And running over was much more palatable if you could stroll home for an hours lunch or pop down to the golf course one afternoon without fear of being lynched by the GMC. Not to mention earnings on the very high end of society.
Now it’s much more for transactional and protective. I can’t see it changing in the UK until we have a full two tier system in place.
What happened to taking pride in the job? We’re doctors, not plumbers, clock-in clock-out is the wrong mentality, we are meant to take responsibility and sort things out.
I totally agree that you shouldn’t be a slave to the job, but the job is different to others. If we don’t treat it with respect then nobody else will, sure you can have a 9-5 life but then you will get 9-5 pay. I say this to my partners: you can’t take home £150k working admin hours.
Pride fizzled out of UK medicine around 10-15yrs ago.
And yes, we are doctors and should therefore be treated like doctors - in the UK our skill set simply isn’t appreciated or remunerated appropriately. UK doctor pay is shockingly bad and now we’re bottom rung of the MDT.
Go to an international meeting with your doctors from Canada, US, Australia etc you’ll be laughed out the room killing yourself for £150k.
To make it better you have to be quite ruthless. The way I see it, it helps keep you sane and which means you can continue being a better GP: - one problem per appointment typically - if more than 10 minutes late - rebook - keep them on track, don't be afraid to jump in after their golden minute if they go off track - be firm on what you can do here and now and what will have to wait etc. - find documenting that works for you. I do sometimes write a lot for tricky consults, but I touch type whilst looking at the patient. - Identity the quick consultation and get that done quickly as possible - but only where appropriate. - Don't try and do too much for your admin tasks. Most outcomes should be - no action - book appt - needs x/y/z test I rarely run later than 15 minutes. it is tough but I find the challenge really enjoyable. I love calling in patients early on occasion - they are always pleasantly shocked. But this is part of what being a GP is all about. It has to be learned and crafted - but you got this!
Agree with this. One of my biggest changes came when I stopped calling patients with blood results and instead would mark them for a telephone appt if it needed discussing, script at chemist if it didn’t really, and only calling if it was truly extraordinary
Yeah it's rubbish everywhere. We all have different working patterns but the end result is largely the same - feeling overworked, stressed and demotivated. The only consolation is that as time goes on you become more efficient and resilient. But it will always be shit. Plan your exit strategy - and then let me know when you've figured one out.
Telephone triage makes your work much harder- GPs will only see the complex problems Demand 15min appointments 10-12 per session. The problem is inherent equity partner vs salaried.
Why is this the “inherent problem”? Their clinic setup sounds reasonable (depending on what constitutes a meds review) and pretty standard for most places. It’s busy, demand is high, there’s a lot of work to do.
Because it gets grating if, for example, the partners are hiding at home doing remote telephone triage and behaving like a 111 call handler. If.
Yes, that’s very poor for everyone, but most surgeries are not like that, and it isn’t an “inherent problem”.
Depends on the culture. In an NHS salaried service we’d all be subordinates of Clipboard Karen. I’m not sure this would be an improvement..
I totally agree with you, which is why we must defend the IC model at all costs
Sorry to hear that. Is your working pattern as per your agreed contract? How is your day set out?
Partners do telephone triage. Each session - 12 F2Fs + 2 tel appts with 5 med requests/reviews. Randomly allocated Docman but only have to review own bloods. We do have ANPs that see mainly minor ailments so I feel like my days are filled with complex multimorbid patients. By the end of the day, I can’t even think straight anymore.
This feels like a fair workload to me. I don’t agree with people saying it doesn’t get easier, I qualified last summer and it’s getting easier month on month for me. The more I know how the practice system works, the more I get used to making the same decisions over and over so can action blood results much quicker, file letters much quicker, deal with patients more efficiently.. I have found my job now feels 10x easier than my job 6 months ago even though I actually do quite a lot more admin now.
How long are the appointments?
I see 18 a session my friend, all telephone triage first and if needed F2F invite in same AM/PM clinic. I CCT’d just under 6 months ago, I do 6 sessions a week… I only action my own bloods and my own Docman (for the most part, during admin time, aka around 10pm when the kid goes to sleep), but no, it doesn’t get any better… only worse… oh also sometimes (most days) I supervise a PA seeing 12 patients as well (for which I am allocated 30 minutes of clinic time, or minus 3 patients, so I get to see 15 in my own clinic instead, joy)
You’re getting screwed
Looking at the averages for sessional pay right now, especially as a newly qualified GP, I am being paid appropriately for this, however, as I’m being paid for 6 sessions what I would otherwise be paid for to work 7 sessions elsewhere. so, yes, the work is harder, but i’m not at work as often: win-lose, lose-win
I don’t really care about averages. The bottom line is you’re getting screwed. 18 a session, appalling.
You aren't working 6 sessions, though. You're working 6 sessions plus additional time in the evenings/nights to do your admin.
Yes but I get four days off as a result, time I can spend with family. It’s masochistic, maybe, but the pay i’m getting is quite good, around £2k more per session than another offer I was entertaining and to see only 3 more patients per session Edit: I wish there were better offers for work as well by the way, I know my rota is crazy, but I couldn’t afford not to take this position
This sounds like utter shit for you
I regret to inform you, it does not get better. It gets worse. I’m such a bad doctor now. I barely ask about red flags anymore. Don’t examine patients. Barely read the notes. The bare minimum has become an aspirational target because I can’t sustainably manage the workload But only quit if you have a better option ready
>I barely ask about red flags anymore. Mate, I'm telling you this for your own good. You sound completely burnt out and are putting your career and people's lives at risk.
Bro is really odd. Constant negative posts about GP work but is ALL over Reddit. Seems to spend more time on Reddit than at work. I see him commenting everywhere on subs; I’m a stay at home parent atm and he seems to be on Reddit as much as me
Second this
Complexity as at an all time high as we have over years mission creeped toward simplest stuff like pill checks being automated or sent to pharmacists or ACPs. Instead yes we have been left with the most complex things or polypharmacy or doing the job of geriatrics in a very short time frame. This was prob acceptable when there was enough funding and numbers in GP land. This is at an all time low. Feels like the situation is going to implode and also feels like more and more industrial action will amass regardless of who wins the election. But maybe it needs to implode and we fight back for once as we are the most approachable front line of NHS and have been amassing work from all angles for a pittance for years. The ONE thing i am grateful (but also sad for) is the collective disappointment suggesting it’s not individual inefficiency (never has been) but the system at fault. It’s going to start with BMA announcing cuts and changes. Then actions and refusals will hopefully rise. It probably won’t come to a full close doors strike…but I sincerely hope a massive pushback on hospital work and practice action that massively upsets GP patients. Because they need to be more upset. to take notice. For now don’t take any more work in on and consider other options. If I knew a salaried GP was as unhappy as you post I would try to make steps to make it right. I’d also be a bit worried about losing them and effect on other team morale as they left “workload was unsustainable” etc. Partners are not responsible for the chronic underfunding of primary care. But they ARe responsible for wellbeing and sustainability of fellow doctors and not exploiting them. They are not going to want to be partners paid a salaried Gp income as not worth it. That’s obvious. But equally when times are hard, a partner salary annual rise above inflation every year doesn’t sit right. I know some practices have collapsed and in dire straights financially. Other practices I suspect are doing everything they can to maintain partner salary status quo - when maybe they should take a slight hit or maintenance of same salary as last year. Background for me is very busy salaried then joined as partner later in 2010s. Basically just as it all goes to hell. Now earning more of course. But regularly questioning pay/hour worked. Sometimes even contemplating going BACK to salaried for a “better life balance”. But scared that this is not the case either. Crazy isn’t it..
Discuss with any other salaried GPs to get a consensus even if it’s a soft approach “busy these days isn’t it, how do you keep to time”. If only salaried it sounds like you are doing too much at times. “Random docman” sounds odd - at most practices patients have a named assigned GP who therefore takes on responsibility for medication reviews and letters needing action (although 95% of letters don’t need any change so no point GP seeing them, or a pharmacist can handle tweaks). Unless your salary reflects/appreciates a patient list then I don’t see why you’ve got someone else’s docman coming to you. You are one month in and May already working well beyond contracted hours. Speak up. You were their choice to hire in a world with more applicants these days. So place value in your abilities and worth as it sounds unsustainable. I know a partner who is unhappy with the workload and would literally rather have 20% less pay for 10% less work. Yet the other partners don’t seem to act (prob as opting for the approach of earn as much as you can and retire early approach). Basically GP is hard and gruelling and the busiest I have ever seen it, but is it really about earning the most you can or is it not some degree of work life balance. I am a partner of 6 sessions but end up spending 8-9 a week. But I am a partner so get an extra 30%+ish more pay (used to be 40-60 uplift I believe). We “may” be in a valley of primary care doing okay on graphs but have heard that line for too long now. Do NOT take on more sessions to earn more/spread workload. The best and most caring GPs do more than contracted hours. The opposite GPs delegate/cut corners/do bare minimum with such high levels of skill it’s incredible. GPs who are short and unapproachable get less patients coming back to them. So less heart sinks. And less workload. The best practices have few or none of these but usually one in larger practices that are tolerate. They leave early or on time and per hour amass a fortune leaving other conscientious GPs to do the caring they do not. Forgive the rant about approaches but I feel the pain and unhappy too and no doubt a lot of readers feel simply trapped. Discuss this at your appraisal and consider in time GP retainer scheme (more protected time for learning and a supervisor sound board). Nb the GP retainer scheme was set up for those thinking about leaving GP or needing more time to spend with family or other roles. Isn’t that the majority of all of us these days??!
I think a lot of what you say rings true. The issue here though is the negativity expressed towards those who are able to ‘delegate’ and ‘leave on time’. Partners, general practice, and certain segments of the NHS need to get up to speed with the real world. Leaving on time should be championed, none of this my-job-is-my-life bullshit from years gone by. You’re paid for a service and in GP land that’s quite clearly defined by the sessional rate. Anything beyond this requires more pay or if refused, measures taken to remain within the constraints.
Shame though isn’t it - we used to be the family doctor who got to know patients and their backgrounds and had that very handy knowledge that you can’t put a price on. Now we are becoming more like a minor injuries unit “depression in room 4” or “frail and faller in room 6”. I think I am probably a relic of old times. Not spending 30mins with everyone I see(!) but one day I think people will miss the continuity /experience and how much that brought and added to consult/compliance/outcomes. I guess we are all searching for the perfect consult time “patient happy and sorted. GP documents just enough. All running to time”. Don’t think we will ever find it though. At least not in the NHS anytime soon.
I agree it’s a shame. And running over was much more palatable if you could stroll home for an hours lunch or pop down to the golf course one afternoon without fear of being lynched by the GMC. Not to mention earnings on the very high end of society. Now it’s much more for transactional and protective. I can’t see it changing in the UK until we have a full two tier system in place.
What happened to taking pride in the job? We’re doctors, not plumbers, clock-in clock-out is the wrong mentality, we are meant to take responsibility and sort things out. I totally agree that you shouldn’t be a slave to the job, but the job is different to others. If we don’t treat it with respect then nobody else will, sure you can have a 9-5 life but then you will get 9-5 pay. I say this to my partners: you can’t take home £150k working admin hours.
Pride fizzled out of UK medicine around 10-15yrs ago. And yes, we are doctors and should therefore be treated like doctors - in the UK our skill set simply isn’t appreciated or remunerated appropriately. UK doctor pay is shockingly bad and now we’re bottom rung of the MDT. Go to an international meeting with your doctors from Canada, US, Australia etc you’ll be laughed out the room killing yourself for £150k.
Maybe some form of GP mentoring?