A Tale of 17 Ambulances

This week was one in which my family used the NHS a lot. My nephew had a heart attack, my sister in law had pneumonia and my mother had unstable angina and had to see her GP. Both my nephew and sister in law were taken to hospital by car and did not use the ambulance service because they did not appreciate the severity of their conditions. They were sorted out promptly and are now well controlled.

On the other side of the country my GP husband arranged for an elderly person to go into hospital for a DVT (deep vein thrombosis). He rang for an ambulance at 11am. The ambulance arrived at 11pm. The ambulance then joined the queue of 17 sitting outside Accident and Emergency for hours, because they let patients in a controlled way specifically to avoid the 4-hour breach.

We were told this by the patient’s partner, and have no way of verifying it, but have no reason to disbelieve it as we have heard it now from a variety of sources.

A doctor finally saw the patient at 11am the next day. I do not know who is in charge of this but it is ridiculous. The IT system works well though, because I received an email about the same patient on the day of admission telling me that the diagnosis was indeed a DVT. For as long as our town continues to follow this silly system we should consider taking our loved ones directly to hospital, as the risk that entails is probably less than the alternative. For my part I will complain to the CCG and weight up the risks and benefits of the local ambulance system more thoughtfully in future.

Life of a GP

http://www.theguardian.com/society/2015/mar/08/life-of-a-gp-we-are-crumbling-under-the-pressures-of-workload
Open the link and read a completely accurate account of what life was like for me as a GP partner before I left one year ago.

In Warrington now I am one of 60 people who are freelance/sessional GPs/locum GPs in order to avoid that excessive workload. That number is about a third of the total number of GPs in our area. We have a monthly study group which I attended last week and which on this occasion was a “significant event analysis” session. We sat round in small groups and each of us brought a case to the table. At the end, each table presented its’ most significant case. As sessional GPs we are more likely to get complaints because we dip in and out,so we have to have extra fail-safe mechanisms for avoiding these, and most of our cases did not end in a complaint.

We have a bird’s eye view of General Practice and we are worried about what we see. One doctor on my table had worked in 24 of out 26 of our local practices in the last 2 years. I have worked in 8 in the last year. There is a book entitled “Mistakes were made but not by me”(Tavris&Aronson) but we all described a mistake we had been part of, and how it had happened, and how it could be avoided in future. We also talked of overworked GPs, nurses and practice managers. Of people working in their holidays in other practices to keep afloat financially. Of people working on Saturdays and Sundays to get the work done because the 12 hour weekdays are not long enough to get the work done. There was the feeling that General Practice had become the dumping ground, often on the basis that GPs earned a lot more money than they should( I do not see this) and did no on call. GPs often get letters from hospital doctors with long lists of tasks to do on patients, as if they are their junior employee. As a result of this sort of thing and the workload overall, some GPs are conscientiously working themselves into the ground and others are leaving to pursue more manageable lives as sessional GPs. I worked in the practice of one GP who routinely went in at weekends to catch up. He looked incredibly stressed, but never complained. One morning I was asked if I could do extra sessions to cover because he had been taken into hospital as an emergency in the middle of his morning session. Three weeks later he was still in intensive care.

We work as sessional GPs so that we can do our best for the person consulting us, and simultaneously protect ourselves from excessive workload. It is not uncommon for GPs to “retire” aged 50-58 but they are not really retiring, but becoming sessional GPs like me. One of my colleagues, who is due to leave in 3 months told me a patient came in last week, sat down and said “traitor…. traitor… traitor” just like that. I am not sure what he said back, because I interrupted and said well, it is better leaving than being dead.

Bear the workload in mind, when you phone your GP or visit him of her. There could be 7000 patients,and only 3.5 full time equivalent doctors. Your 10 minutes is very important to you, and it is only 10 minutes of his 12 hours. Some people try to fit in 5 separate problems. Think about what can be properly achieved by you and your GP in that time.