Intended for healthcare professionals

Views And Reviews Primary Colour

Helen Salisbury: What do GPs do all day?

BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2716 (Published 09 November 2021) Cite this as: BMJ 2021;375:n2716
  1. Helen Salisbury, GP
  1. Oxford
  1. helen.salisbury{at}phc.ox.ac.uk
    Follow Helen on Twitter: @HelenRSalisbury

One of the joys of general practice is the variety it offers. The clinical breadth keeps us on our toes as we switch from new baby checks to palliative care, diagnosing surgical emergencies or dealing with mental health crises, and caring for patients with long term conditions, all in the space of a single surgery. When things are working well there’s a lot of liaison with hospital colleagues, specialist and district nurses, pharmacists and paramedics, and social workers and social prescribers, all aiming to keep patients well or ease their suffering.

Many GPs have extended roles, developing expertise in particular clinical areas and running community clinics in specialties such as cardiology or gynaecology. I’m grateful to those who take on leadership roles in the NHS’s ever changing alphabetti-spaghetti of governance structures (we’ve had PCGs, followed by PCTs, then CCGs and now PCNs and ICSs, not to mention LMCs). Others devote energy to teaching the next generation of doctors in medical schools or through postgraduate training, or they contribute to our evidence base through research. And we need to take time to educate ourselves and each other, as it’s no small endeavour to keep acceptably up to date with the range of clinical conditions we see each day.

While doing all of this, we’re still GPs. One of the most depressing aspects of the recent GP bashing in the national press is criticism of the “part time” nature of many GPs’ work. It’s been pointed out that a nurse who puts in three 12 hour shifts is regarded as a dedicated hero/heroine, whereas a GP who does the same is regarded as a part timer who’s somehow failing to pay back the nation’s investment in her training. And yes, it’s nearly always women who are the subject of these complaints.

A major problem is the invisibility of much of our work, even within the surgery. The publicly visible parts—the face-to-face or telephone appointments—may be timetabled as surgeries lasting three or four hours. Some of us aren’t very good at running to time, but even when we’ve closed the door or hung up the phone there are prescriptions, laboratory results, hospital letters, referrals, emails, e-consults, and home visits waiting for us, which take many more hours. With good organisation and enough support staff some tasks can be delegated, but many still require a decision by a doctor. The colleagues we’ve recently welcomed to help us—physiotherapists, pharmacists, and paramedics—all need training and supervision as they adapt to the world of primary care.

We may be teachers, researchers, specialists, or leaders, but we’re still GPs, and we need to count (and be proud of) all of our work that’s material to that role. We must also be realistic about how many hours doctors can safely be expected to work, as there are too few of us. We’re weary of successive broken promises of more GPs, and we desperately need measures to stop experienced colleagues retiring early. Respect from our political leaders would be a small step in the right direction: they could at least try to counteract, rather than amplify, the increasingly toxic narrative about who we are and what we do.

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