Dave Mummery is a a member of RCGP ethics and governance committees and honorary research fellow at Dept Primary Care and Public Health, Imperial College, London
The year is 2027…
INTs (Integrated Neighbourhood Teams) have been up and running now for two years and now are in every corner of the UK.1
In a glimpse two years into the future, a typical day for a GP in the INTs is speculated upon.
7:15am:
Arrive at my cubicle and log on; currently the average time for the EHR to get up and running is 35 minutes, so I go and make myself a cup of coffee whilst I wait.
Bump into Brendan, one of the physios on the way to the kitchen; he tells me that he has added four patients to the end of my list as he did not know what to do with them and they were all very anxious.*
I go back to the cubicle and put my headset on.
8:30am:
The AI triage tool has ‘independently’ booked 12 patients, all with completely normal results to speak to me…
The AI triage tool has ‘independently’ booked 12 patients, all with completely normal results to speak to me, having automatically texted them that they “very urgently” need to speak to a GP. Twelve highly anxious phone calls ahead.
Great….
9:30am:
Anushka head of the ICG pharmacy dashboard network team puts her head around the door letting me know that they had not issued thirty-five of the prescriptions because they all needed a medical review and that I might get ‘some messages’ about it from the dashboard team about it this afternoon.
An instant message immediately comes up on the screen from the care co-ordinators office that Mr Jones is in the foyer “very angry” that his Epaderm prescription was rejected.
9:45am:
Meet the extremely angry Mr Jones and calm him down. Agree with him that the INT system is “complete crap” and just for the pure thrill I print out the Epaderm prescription on a FP10 and sign it by hand with a squiggly signature with the new fountain pen I have just bought.2
10.15am:
Still speaking to Mr Jones about how awful the new INT system is. It looks like he has had enough, he makes his excuses and leaves the room with a pitying look on his face.
11am:
Barbara, one of the dieticians, instant messages me and says she has “put it in an email as well” that she is going to send to me.
Apparently one of her regulars “might have overflow diarrhoea” and could I urgently review.
Before I have a chance to respond I CAN SEE A NEW SLOT AT THE END OF MY SESSION BEING CREATED CONTEMPORANEOUSLY ON MY SCREEN, THE PATIENT BEING PUT INTO IT, AND THE NOTES SECTION NEXT TO IT NOW SAYING “OVER FLOW DIARRHOEA AND FOR PR EXAM” …..
I THEN REALISE I HAVE PRESSED THE CAPS LOCK BY MISTAKE WHILST WRITING MY REPLY TO BARBARA, AND HAVE TO DELETE IT ALL AND TYPE IT OUT AGAIN.
I am not sure I can take much more of this….
Midday:
One of the first contact practitioners (I’m sure he used to be a PA?……anyway…) tasks me a prescription of twenty Mounjaro pens to sign off.
1pm:
Grab a coffee and sandwich, go back to the cubicle, and look at my afternoon list.
45 patients to go, some pre-triaged by the INT and added onto my list by them and the rest added automatically by the AI chatbot.
3pm:
Oh, joy…..absolute joy.
All my F2F 2:50pm patient had was simple UTI symptoms and nothing else.
I somehow managed to knock the urine pot over on the table and had to mop it up in front of the patient with paper towels; the patient left my room faintly perplexed that I had been so happy.
4pm:
Phil, the INT manager emails me asking why I am running thirty minutes late with my list.
5pm:
Only have fifteen more patients on my list, and the end is in sight.
One of the new “team integrators” sends me a task. He wants to know how the integration team can integrate a patient who had a cardiac arrest on Tuesday and would I have time now to “have a chat with him about it”
6pm:
I THEN REALISE I HAVE PRESSED THE CAPS LOCK BY MISTAKE WHILST WRITING MY REPLY TO BARBARA
Urgent task sent to me by the co-ordinating team. Two requests for home visits were made this morning but someone forgot to inform me. No-one else is around who can do them as the paramedic has gone home. For one of the visits in the notes says that the patient “threatened to stab a carer” a couple of weeks ago, and social services have asked for an urgent mental health review and assessment. The co-ordinating team let me know they will forward me the email and also copy the social worker in so I can liaise with social services directly.
7pm:
Leave the building to go and do the two visits.
It is dark outside and heavy rain has started to fall; I zip up my coat, put on my EarPods to listen to the radio, put my rucksack on and then start walking down the road.
On the radio it is playing It’s In The Rain by Enya3
Seems appropriate.
References:
- https://napc.co.uk/our-programmes/integrated-neighbourhood-teams/ [accessed 16/4/25]
- https://youtu.be/xQuUN1HGa0c [accessed 16/4/25]
- https://youtu.be/__aCeZSxSmA?si=0tCQqoCC92BziHyF [accessed 16/4/25]
*Author’s note: All the named characters are totally fictitious and any resemblance to real persons, living or dead is purely coincidental.
