‘I love my job. But days are long and stressful, administration is relentless and the demands on the NHS are increasing...’

There are fears general practice is heading towards a “crisis” due to a chronic staff shortage. In some areas it has led to surgeries closing or being handed back to health boards. So what’s is actually like working as a GP in such difficult times? Dr Sim

IGUESS it would help to describe a Monday as that seems to be the most universally-despised day of the week for most people.

I tend to wake between 7am and 7.30am – my two primary schoolaged sons see to that.

I have to confess, I am not a morning person, unlike my wife who is often up for a cycle, run or swim any time from 5.30am.

Mornings are the usual family chaos as my wife and I both work (she is not in a medical job), trying to cram some breakfast or a coffee into myself while gathering the usual items for the day and getting the kids out the door.

I am usually out the house by 8.30am, the same time as my surgery doors are being opened by the reception team.

Many GP colleagues extol the virtues of dealing with the paperwork at the start of the day before the patients start arriving.

I am sure they are right; I’ve just never quite managed it. I know there will be a large inbox of 40 to 60 results and 15 to 20 out-of-hours GP reports to acquaint myself before the end of the morning.

My commute is usually a cycle ride down the Taff. I am very fortunate to work in an inner city practice with a small practice area of four square miles, although densely populated and growing (we currently have 8,000 patients registered).

It means that, even when house calls are required, I can manage quite well on a bike, although the Welsh weather means I have been known to show up to a house call wearing my lycra, as my work clothes would have been sopping by the time I arrive.

It’s one of the reasons I chose to work where I do as I hate driving.

I have worked as a locum across with south Wales in the past, as far away as Blaenavon.

I absolutely love south Wales Valleys communities – they are the most big-hearted, lovely people – but I could not tolerate the commute.

The population I work in now could not be more different.

There are 40 different language groups in a one-mile radius of the surgery and a very broad mix.

When my senior partner set up the practice 20 years ago, she noticed that most of the homeless people in Cardiff fell into our practice area. We still serve the large hostels in Cardiff.

At the other end of the spectrum, the Bay has a great deal of young professionals, artists, TV actors and international business people.

“From penthouse to doss house” is how my senior partner would describe it.

We are unusual as a practice for still running our morning surgeries as ‘open’ clinics, which means there are no fixed appointments.

Everybody who shows up between 8.30am and 11am will get seen in the order they arrive, unless clinical priority requires it.

Sometimes 20 patients will arrive, sometime it will be 60 – we do not insist that appointments are ‘emergencies’.

Our patients know to expect a long wait, which could be two or three hours or more.

But the positive side is, there is no telephone scramble for appointments (which would disadvantage the homeless and those with poor English) and the next available appointment is always a maximum of 22 hours away.

The reasons for consultation will naturally vary considerably.

One of the challenges of general practice is that one never knows what is coming through the door.

There will be a fair few patients with suspected infections, but there is always the possibility that one of those coughs is something more sinister, and some patients will already fear this.

Managing patients with a nonserious illness who is terrified of a serious diagnosis, or patients with a serious illness, which they have dismissed as trivial is challenging, especially in the few short minutes we have together.

Being clinically vigilant and a good communicator is essential, and still sometimes we will get it wrong.

The 10 minutes we have for the appointment also needs to include rigorous safety-netting to ensure the patient knows what to expect, what to look out for if things change, as well as documenting all of that in the medical notes in case they come back to someone else.

And that’s all before we move on to the second problem. I have never been a ‘one-problem, one-appointment’ kind of doctor, but sometimes we will have to put problems off to another day in order to do them justice.

I once calculated about one in four of a GP’s consultations is primarily about a mental health problem, and that certainly seems to be the case still.

Mental health is a particular interest of mine and I consider myself to be quite psychologically minded in managing it.

I recognise the value of medication, but it’s a small proportion of treatment. Helping patients to value and access good quality psychological resources is far more important.

Among our population, there is also a high level of drug and alcohol use and this needs to be treated too.

Mental health problems are also the leading cause of absence from work and worklessness and so a large proportion of consultation time will concern Fit Notes, work capacity assessment forms and, inevitably, supporting appeals for people who have been found fit for work.

I don’t consider myself to be an occupational health specialist and, having never stepped into a patient’s workplace, this is one area of my job that I find particularly exhausting.

By the end of the morning (by which I mean somewhere between 12.30pm and 2pm depending on the number of patients) I am tired, thirsty and in need of a rest.

It is time to tackle the eight or nine requests for telephone consultations, some of which may be house call requests, and if I haven’t already, tackling the results and out-of-hours