At Fountain Medical Centre, we believe that all patients should have access to quality care and we understand that this is provided by more than just a “face-to-face” appointment.
We’ve sat down and shared the stories of some of the clinical team here at Fountain Medical Centre, as they share some of the work they do behind the scenes to support our patients.
6:15am alarm goes off
7:15 leave for work, taking flask of hot drink and sandwiches!
7:50 arrive at the practice, turn on PC and check in-house emails and messages/tasks from previous day(s),
8:10 start morning surgery- mixture of telephone call backs/e – consults and face to face. Telephone- some patient need to be seen so book in for later that day or another day, some I can manage with use of web-cam or text message sharing of photos.
E-consult requests,- again, some need to be seen/are not simple and need calling back then and there, or information/sick notes sent through electronically, or appointments to be arranged at a later date
Face to face appointments – these are either patients myself or another clinician has spoken to, or some booked directly by reception: for example, new Mum and baby checks, new lumps found, abnormal bleeding, chest or abdominal pain, unwell babies under one.
In the 10 minutes of each consult, I must greet the patient/check id if on phone, get the history of the problem, examine them if face to face, formulate a working diagnosis, decide on course of treatment, check allergies if I’m prescribing, check interactions with other meds, arrange suitable pharmacy to send the prescription to (this being done electronically since Covid), and discuss how we’ll follow up.
OFTEN APPOINTMENTS TAKE LONGER THAN 10 MINUTES, especially if there is complex medical history, elderly patients on lots of medications, mental health issues that require sensitivity.
We have 20 x 10minute ‘slots’ which are used flexibly depending on patient requirement but I hope to have finished the bulk of the morning surgery by:
11:30am time for a drink from the flask! Then I triage my visits (up to 3 requests per doctor each day) these are housebound patients with medical problems; some can be managed safely having spoken to them without need for a visit, but if they need a visit they are allocated to our very experienced Advanced Nurse Practitioner, or to the relevant GP in the case of palliative care requests. I might also need to arrange paperwork following a death which can only be completed by a GP
12 noon I do my personal call back list- patients I’ve felt the need to follow up myself – for example, a young man with depression starting some medication; an elderly lady having had repeat blood tests; getting in touch with a patient to see if his blood pressure has improved, or offering condolences to a patient whose spouse has died. These are usually a telephone call, maybe taking 5 minutes each, but more recently I have tried to use text as a means of communication, especially for workers.
12:30 time to check my ‘task’ list – perhaps 10-12 messages by now- from admin staff/secretaries/District nurse/Health visitors/Physiotherapists/Palliative care team, and some I have generated myself as ‘reminders’ to contact patients. Some are more urgent than others- I might have a request from District Nurses for antibiotics for a catheterised patient; or a message from Palliative care nurse to do an urgent prescription for End Of Life care.
I also need to sign off my share of prescriptions, this is a list of between 30-100 digital ‘signatures’ to do every lunchtime
1:00 pm Meeting – usually virtually – we have partners meetings on a Monday and clinical meeting for the whole team on a Wednesday- these last an hour or so- range from safeguarding training/discussion of complaints or significant events/how are we managing the Covid vaccine clinics/staff shortages and recruitment/new drug uses/discussion of our patients on the palliative care register/outside speakers regarding new services of benefit to the patients…
Eat my lunch at the same time…
2:00pm I might have time to do more tasks or check bloods (30-60 results per doctor to check most days); or make a start on the list of referrals that have been generated in the morning (to be typed up and sent by our secretaries)
2:30pm start afternoon surgery
Again this is a mixture of phone contacts and face to face. In the last few weeks I have seen ABOUT 9 patients face to face and 5 call backs. Each allocation is 10 minutes but often things take longer.
BETWEEN FACE TO FACE PATIENTS I MUST CLEAN DOWN THE CHAIR, HANGE COUCH ROLL AND CLEAN COUCH, AND INSTRUMENTS I HAVE USED AND CHANGE MY PPE. This takes a few more minutes of precious time!
In the course of the day, we are also routinely required to deal with urgent queries- I have mentioned the community nursing teams who have urgent requests, but also ambulance staff, Social workers, coroner’s office, occasional hospital doctors all call up and we try our very best not to keep these colleagues waiting. This might be why you might wait a little longer outside the door of your GP!
5:30pm surgery over, I now try and clear my blood tests, and referrals.
I might find a report about a spread of a cancer, so I’ll call that patient to talk about it then and there, or find a really abnormal blood test which will need repeat, I would likely find a slot with the nurse to book into, again contacting the patient.
I’ll also check my pigeon hole for reports that need completing- which range from solicitors reports on an injury, a patient wishing to join the police, a letter regarding a bus pass or holiday cancellations or to aid a patient claim benefits. These take about 5-30 minutes each.
6:30-7pm TIME TO GO HOME
I’ve had between 45 and 50 ‘contacts’ with patients today. I’ve done an average of 10 referrals and checked 40 blood test results, signed off 50 prescriptions and dealt with a further 12 tasks, and done a couple of reports. Hope my other half has got the tea on…