My day normally starts at 06:30 when my three and seven-year-old alarm clocks charge into the bedroom. I'm usually at the practice for 07:45 to clear the day's mail, repeat prescription queries and test results before morning surgery starts at 08:30. This comprises either 15 booked routine appointments or between 20 and 30 drop-in emergencies, followed by a number of phone consultations and usually at least one home visit. I seldom finish surgery on time these days as the complexity of patients with multiple problems is managed more and more in general practice rather than hospitals.
I really enjoy the challenge of more complex patients and they seem to value a stable relationship with a clinician they know and trust. This does have an impact on my time though, and combined with working in a deprived city in a time of austerity and an exponential rise in the expectations of the worried well, workload has risen year on year in recent times.
General practice in Britain is one of the developed world's only examples of truly holistic generalist medicine. It's what attracted me to being a GP and what continues to drag me into work on cold dark January mornings. It still frustrates me how the system can fail its most vulnerable users. This isn't due to a lack of ability or hard work by frontline professionals, but when the organisations those professionals work for do not integrate properly, patients and their families fall through the gaps.
Take Mr S, for example. He has worsening dementia and physical frailty. He lives in a bungalow with his wife and no other family close by. He's been admitted to hospital as an emergency four times in 12 months, had some time in respite care and is under three hospital consultants. I know he's vulnerable, social and community services know he's vulnerable but we have failed to work together closely enough to prevent his wife from having to ring 999 at 11pm last Sunday night. He is currently an inpatient again, confused and frightened and awaiting an increased social package.
I try to grab a sandwich in the practice staffroom but usually eat at my desk or in the car, or skip lunch altogether.
These days, my afternoons vary greatly. If at the surgery, I will do a couple of hours paperwork, increasingly helping patients challenge draconian decisions taken by agencies working for the Department of Work and Pensions with seemingly little concern for an individual's health. There's then a children's drop-in clinic, more phone calls and seeing any adult emergencies that pitch-up or any afternoon home visits. I try to leave surgery just before we close at 6:30.
Since April, I have been a GP governing body member of Liverpool clinical commissioning group and I now spend four half-days a week as a clinical commissioner. This involves lots of meetings with our team, with other NHS trusts, patient groups, and our colleagues in Liverpool city council. The increasingly frail population and the frankly unfair cuts to our local authority have meant that close working is now more vital than ever and the changes we make will need to be revolutionary in both size and culture.
As a commissioner, my working day never officially ends as there is always a lot of reading to catch up on - my success with this is variable! I will receive an average of 75 work-related emails daily so always need to spend some time of an evening catching up on these, which is never very popular with my family.
I manage to have dinner with the kids two or three times weekly and try to get out for a pint with a mate or to rehearse with my band at least once a fortnight.
I usually crash into bed at around 11 and have one last final mental run through the day to make sure I've not missed anything. Then I drift off to sleep, dreaming of scoring the winning goal for Liverpool in the cup final.
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