Dr Somebody* is a fictional late middle aged, mild to moderately burnout GP Partner in North London; he is suspicious about the current managerial changes in the NHS; his motto however is “contented with little, yet wishing for more”, and at heart he is an ‘sceptical optimist’ . He tries, (however hard), to ‘See the funny’ in as much as possible…
Dear Reader,
Highbury Groves GP surgery used to be a residential townhouse called “The Laurels” in the nineteenth century and was a family home here in a leafy near-suburb of London! How things change! There are so many changes in General Practice currently, and with the current “NHS and GP crisis” I’ve decided to keep a diary of my working life here at Highbury Groves GP surgery for 2023, so here goes!
Yours Faithfully,
Dr Somebody, GP Partner
Monday
Got in to the surgery early today as had some hospital letters and results to go through before the start of clinic. Our local hospitals seem to think that GPs have nothing to do all day, and all the letters are asking for the specialists’ tests to be requested and followed up by the GP. Apparently, it’s part of the new Integrated Care System – ICS, or ICB or whatever that actually means in practice!
Some of the hospital letterheads have no phone numbers or contact details on them at all…
I could see, across the corridor that by 9.45am Jerry had just arrived in the management office: since appointing himself “Managing director” of the surgery, he’s stopped seeing patients almost entirely and he spends his whole time paying himself 10 sessions a week, attending various PCN meetings, “very important” ICB and “place-based” (what the heck is “place-based” ?!) events and various other non-clinical work, mainly involving long meetings, many types of biscuits and possibly a power-point presentation with lots of indecipherable diagrams with many arrows pointing different directions thrown in. Total “Management-speak verbiage” (or was it garbage?) I think Nisha once described it as…
It’s almost as if he will do anything other than actually have to see a patient…
Looked at the on call list : 35 patients on it already by 9:30am…
Saw Julian walking in from the surgery allotment. “There’s going to be some fantastic cucumbers this year!” he exclaimed heartily. He won an award for a prize turnip last year. Julian’s grown a bushy, greying moustache and sideburns… I think it makes his face look a bit “cluttered”, along with his horn-rimmed specs…
Tuesday
Had one of the best consultations of my career this morning. A patient had witnessed me slightly cough once in the waiting room and then refused to see me, and then he hurriedly rushed out of the surgery doors. Absolute result!
I should try coughing more often in the waiting room…
It’s a dull grey day today but at least not raining. I saw that Sinead was back at reception having been off work for a week. Apparently, it was her sister Mary who also used to work at Highbury Groves, that had sprayed the “…All the doctors here are totally crap” graffiti last week over the fire escape at the back of the building in a purple coloured aerosol ; it was all caught on a security camera – I’ll have to try and watch it sometime…
Adam’s gone ballistic and is up in arms about it and has given her a third official warning letter, but, to be honest she wasn’t that inaccurate in her assessment, and it certainly livened up the grey concrete.
I had given Sinead two bottles of gin that a patient had given to me at Christmas…Feel terrible about it….but didn’t know Sinead had a drink problem. Hopefully she can get back onto the wagon again soon..
Wednesday
Highbury Groves is trying to appoint new partners at the moment, but it’s proving a nightmare : none of the younger GPs want to be partners and they all say that they want to have a “portfolio career,” whatever that is. I know I’m old but what does a portfolio career mean? Looked it up in the dictionary and it gives the definition:
a) “a large, thin, flat case for loose sheets of paper such as drawings or maps” or
b) “a range of investments”.
I assume the younger GPs mean the latter but it’s still quite an odd term….maybe it means anything else other than having to become a GP Partner?
There was only one GP called Basil, who came for interview, and the whole partnership of seven of us (me, Jerry, Julian, Nurlina, Kay, Anya and Kivs) dialled in to a Zoom interview with him..
He seemed to have a repetitive nervous tic of repeatedly shaking and nodding his head in a jerking movement, whilst sort of grimacing and clenching and grinding his teeth at the same time.
We offered him the partnership on the spot, (despite the fact that he was accidently on mute half of the time) but he said he would think about it and get back to us if he was interested.
Was a bit disconcerted when he seemed to have a prolonged spasm of this after I asked him if he had enjoyed his GP registrar year, but then realised he had been a GP registrar at Lannister Road surgery with Dr Joffrey so that explained everything… no doubt severely traumatised by a year there. Poor guy…probably Lannister-induced PTSD.
We offered him the partnership on the spot, (despite the fact that he was accidently on mute half of the time) but he said he would think about it and get back to us if he was interested.
Thursday
Chatted with Anya one of the other partners over coffee before surgery: she really is very lovely but doesn’t like the way the surgery is going under the management board. She feels the surgery is becoming far too corporate with endless finance meetings, targets, care plans, VAT for ARRS roles, other costs, PCNS, ICS etc etc ad nauseam.
She seemed slightly down and a bit burnt-out: she’s wonderful with the patients and they all love her. I’m worried she might leave (she can’t! She’s my favourite colleague!).
She was on call yesterday, really busy as usual and she had done a home visit on a terminally ill man, who lived alone: Anya had lifted him off the floor herself and tidied up the flat and did some shopping for him as well as attending to all his medical and palliative care needs….now that’s what I call real General Practice, not sitting in some stupid ICB, “place” (Lord, give me strength…), or PCN meeting all day like Jerry and Adam do..
Just heard Adam, Jerry and Georgia who is one of the other management board GPs in the PCN (she’s at St Stephen’s Park Surgery) want to convene a meeting about the recurrent problem of patients not attending their appointment. I personally don’t see any “Problem” with DNAs…
Caught Kay in the act of moving two of her reports from her pigeon hole into my pigeon hole; she rushed off down to corridor and then went into the toilet without saying anything when she saw me…Anya had told me she was sure that Kay was re-allocating most of her blood results to other people as well.
Anya also said that she was still struggling with what happened with Nisha , who left the partnership last year. Nisha was kind and charming and the patients just adored her…I remember her once driving a patient to A&E herself at 9pm at night : she did attract many more “difficult” patients though, and because she was so caring patients gravitated to her like bees around a honeypot – I think she is what is known as an “empath”.
Nisha developed Long Covid back in April last year and had to take some time off as she was feeling so unwell and at a Partnership meeting a majority (4 vs 3) of the Partners voted to remove Nisha from the Partnership as she was “unable to fulfil her Partnership duties”…
Nurlina stopped me in the corridor and demanded to know why I had advised a patient to speak to her about a referral that she had done. Before I could say anything Nurlina was storming off saying that she had added three patients to the end of my telephone clinic tomorrow, as she had to head off early to her Zoom pilates class… Nurlina had some new huge diamond earrings on to go with the pearl necklace she got last month…
Friday
Got screamed and shouted and sworn at by a 32-year old patient who was wanting a home visit for an ingrowing toenail but he had been staying 15 miles away in for the last few months….he couldn’t seem to understand that a 30 mile round trip for me, with an on call list with 63 patients on it probably wasn’t appropriate, even if his toe was looking a bit red. He slammed the phone down as I ‘EPSed’ the flucloxacillin to his local pharmacy.
Three instant messages flashed up on my screen one after the other: the first was from Lindsay the new social prescriber: the message was to inform me that three of the patients he had seen in his 45 minute appointments this morning had scored very highly on the LONER score (this is the new ICB loneliness screening assessment tool) and that he was adding them onto my on call list; the second was from Helen the PCN pharmacist: she was horrified that a whole cohort of patients taking PPIs had not had their serum Magnesium level checked recently and she said she was sending me an attachment to go through with the list of patients that needed it doing : there were 456 of them on the list! We never used to check the serum Magnesium on these patients but it seems it’s on the pharmacy guidelines; thirdly it was Brendan the PCN physio had added a 28 year old man to my on call list with the comment “Shoulder pains, not getting better- anxious++++” next to it…
Walked past the surgery meeting room, on the way to the kitchen, in the afternoon, just to get a glass of water and a brief respite from the on-call. Caught a glimpse through the door window panel of Jerry and Steve the senior partner from one of the other surgeries in our PCN (South St Surgery), talking with their facemasks on.
There are so many changes in General Practice recently it’s difficult to keep up! Steve is obsessed with digital General Practice and thinks there’s a fortune to be made in it apparently (all video consultations, digital apps etc, although surely now everyone is doing it what’s the unique selling point?); also I’ve also heard that there’s a consultant at the trust, Ed, who is very interested in an “integrated” model of working with Primary Care as part of the ICS; he may be paying us a visit.
Kay told me that there was a Bristol based “Super-Practice” called “Serendipity” who may be interested in merging or working together – Nilesh the Chief Exec is coming over next week along with Prof Nigel Holding, who apparently is now with the FT Medicals group who have now taken over about 30 practices over the last couple of years.
And then finally there’s Sid Lamington who is the senior partner of Barnsbury by The Green Surgery – he also apparently wants to collaborate! Sid’s such a talented guy – apparently he hand-carved the wooden statuettes outside of the surgery (well… it’s more like a village) himself. Sid took over Elia Street surgery last year that was nearby; it had been a single-hander GP there for many years, Dr Lamb who was a local legend..
All in all it’s clearly going to be a busy and eventful rest of the year and that’s just with ongoing pandemic, flailing Tory regime, post-Brexit stagflation and cost of living crisis, soaring energy and mortgage bills and service charges, AI chatbots, endless digitally enhanced patient demand, the new ICBs, the new Secretary of State for health, the Strep A outbreak, endless medication shortages, all the vaccination booster clinics and the ongoing winter General Practice Armageddon and quite possibly actual worldwide nuclear Armageddon…..well at least Putin and the escalation of World War Three sometimes keeps GPs off the front page of the Daily [obscene expletive removed by editor]!
We GPs should be thankful for small mercies…..!
*Editor’s Note
Dr Somebody is written by Georgia Avon, author of The Stocktake Antimatter https://bjgplife.com/futurism-gp-2031-the-stocktake-antimatter-part-1/
Featured photo (Doctor Somebody tells us the surgery ‘sort of’ looks like this, but is somewhere completely different) by Jonathan Chng on Unsplash
