FEATURE: A day in the life of a Doncaster GP
Rooted in the heart of every community in Doncaster, and across the country, GPs are our first port of call for every ailment and medical concern we have from the moment we are born until our final days.
We trust doctors to treat us for symptoms for everything from the chicken pox to cancer, from depression to diabetes and often within the tight 10 minute window usually allocated for appointments.
But what is it really like to be a doctor in Doncaster today, with the different pressures and responsibilities?
I shadowed Dr Dean Eggitt at his practice at the Oakwood Surgery in Cantley for a day to try and find out...
When I walk into the waiting room at the surgery first thing, it appears to be a picture of calm with just two people patiently waiting to be seen.
But behind the scenes, it’s a different situation altogether and by 8.30am Dr Eggitt, who is one of the practice’s four GPs, has already processed 85 blood test results, reviewed the medication records of around 10 patients and conducted a handful of telephone consultations in the space of an hour.
At the Oakwood Surgery, one doctor a day is placed in the ‘hot seat’ and conducts dozens of telephone consultations, only asking urgent cases to come into the practice for a physical consultation in a bid to free up the resources of the other GPs, hopefully meaning they may be allowed to spend more face-to-face time with their patients.
On the day I visit, it is Dr Eggitt’s turn to be on telephone triage.
Patients speak to the surgery’s receptionist staff who take brief details of their medical complaint.
They are then called back by Dr Eggitt, who treats them over the phone if possible. If not, he invites them into a surgery for the next available appointment.
As I listen in to the 40 telephone consultations he conducts with patients during the course of the day I am there, no two phone calls are the same with each patient presenting with different symptoms and all needing something different from him.
One patient treated over the phone by Dr Eggitt, who also represents the borough’s GPs nationally in his role as a local medical secretary, was an elderly woman with an inguinal hernia, which left untreated could have led to her bowel becoming gangrenous and resulted in death.
Following a previous consultation at the hospital Dr Eggitt then had to persuade the patient to have surgery, which he says can sometimes be difficult.
“Surgery can often be quite a scary prospect, especially for people who are a little bit older, but in cases like this one it’s our job to make sure they realise it’s the best option and could have potentially disastrous consequences if another treatment path is taken.”
By 9.30am Dr Eggitt has already treated 10 patients, and says he is already beginning to feel a little ‘burnt-out’.
He said: “I’m already feeling tired and anxious because of all of the work I know I have to somehow fit in before the end of the day.
“I’m desperate for the toilet, I’m hungry and I need to have a break to clear my head. But then when you do allow yourself a break you’re worried about all of the additional work that may have come through by the time you get back.”
And not only does Dr Eggitt have to worry about the potential consequences if he fails to make the correct decision on a patient’s condition treatment or medicine, but he is also responsible for the decisions made by the surgery’s nurse practitioners and junior doctors’ who all rely on him for support and medical advice.
“It’s like a tree, and GPs are at the top of it,” continues Dr Eggitt.
“If one of my nurses or my junior doctors make a mistake then I’m responsible. It’s as simple as that.”
This high-level of responsibility placed upon the shoulders of GPs in Doncaster and across the country means that doctors are more at risk of drug abuse, suicide and divorce than the rest of the general population, according to the British Medical Association.
Treating patients for mental health, and spotting the signs when a person is struggling to cope, is another important role of a doctor.
Dr Eggitt says that the first few moments can be key.
He said “I can usually tell within the first 10 seconds if a patient is open to telling me what’s wrong.
“As a doctor you have to adapt your approach, and the way you speak, to each patient based on what they need from you, and the information you may need to get from them in order to be able to treat them properly.”
One patient that calls in to speak to Dr Eggitt initially says he is calling because he needs treatment for a gambling addiction.
But after Dr Eggitt speaks to the patient about what else is going on with them he discovers that they have recently been through a series of significant life changes including a change of job.
Concerned that the gambling addiction could be symptomatic of something else such as depression, Dr Eggitt invites the patient in for a consultation where he assures them they will be able to receive the help they need, leaving the patient tearful.
“We know that men between the age of 25 and 45 are a high-risk group for suicide. And while this may not be the case here, it’s always better to try and check them out for it at this stage. If a man is reaching out for help, it often means they are on the brink.
“Men are more likely to commit suicide without saying anything, whereas women are better at trying to get help first because they’re better communicators.”
Throughout the course of the day Dr Eggitt treats around 45 patients through telephone and face-to-face appointments for conditions including annorexia, bowel cancer, gastro-enteritis, genital warts, kidney failure, depression, gout, lung cancer, sinusitis, eczema and diabetes.
When asked about his job Dr Eggitt says he loves it and never regrets his choice of career, but admits that it takes its toll on his family life and emotional wellbeing.
He said: “Sometimes I feel like who I, Dean, am as a person, as a husband and father gets forgotten because of my responsibilities as a GP.
“It can take me hours to switch off, constantly worrying about different things relating to my day.
“What you see as a doctor stays with you. I remember every single patient of mine who has died. I remember every single patient of mine who’s struggled and I’ve been able to help.
“You can’t forget those things.”
A spokesperson at NHS Doncaster Clinical Commissioning Group (CCG) said: “We recognise the pressures and workload GP services in Doncaster, like many other parts of the country, are experiencing.
“The support and ideas we have had from our local GPs have been key to the development of our future plans to support general practice in using different ways of working. It is vital that we continue to work together
to provide effective and sustainable services.”
Dr Richard Vautrey, BMA GP committee deputy chair, said: “GP services are under sustained and intolerable pressure from a combination of rising patient demand, contracting budgets and staff shortages.
“In many areas, including Yorkshire, this is pushing GP practices to the brink with staff facing burnout because they are attempting to deliver increasing numbers of appointments to patients without the resources to do so. The government has to ensure it delivers on its promises, made after lobbying by the BMA, to implement a long term plan of investment in order that patients can get the service they deserve.”
• The evolving role of a GP:
Within a month of the NHS being formed in 1948, 90 per cent of the population had registered with a General Practitioner, used as the gateway for receiving medical treatment and controlling access to specialist care.
And as the role of a GP has evolved over the space of the last 68 years, so too has the variety of pressures placed on doctors.
Hospitals used to share more of the burden that doctors are now faced with. Once upon a time a person who had suffered a heart attack would spend at least three weeks in hospital, but now they are discharged within days and back to the care of their GP.
Similarly, women who had a normal birth would be kept in hospital for one week, and now they are sent home within a few hours.
According to figures from The Guardian, GPs see about 1.2million people every day, managing around 80 per cent of health problems for around eight per cent of the NHS budget.
Dr Dean Eggitt says GPs only send people to hospital as a very last resort, and can face a multitude of questions from hospital staff if they appear to have sent someone to hospital who could have been treated within the primary care system.
He adds that this is because all aspects of the NHS are currently struggling to treat the huge number of patients with the amount of resources allocated.
“It’s all about money, we simply don’t have the funds to treat people to the standard we would like,” said Dr Eggitt.
He added: “Ideally, I would like to provide patients with a platinum service, but the amount of resources and time I have means that I and other doctors are forced to provide a bronze service instead.
“What I would say is that if you don’t need to use the NHS then don’t. We want to help everyone that needs medical treatment, and if you need to see a doctor then come in.
“But if you don’t need to see a GP or go to the hospital, then don’t.”
Practice Manager Clare Boyall has worked at the Oakwood Surgery for three decades.
She says she has seen many changes in the role of a GP in that time.
“In my opinion doctors now have more paperwork to do, and on less money,” said Clare, aged 49.
She added: “The medicine side of things has definitely improved.
“There have been some great developments over the last 30 years.
“But the doctors now have to jump through far more hoops to get the same amount of funding and resources they used to.
“In the old days GPs came in, saw their patients and then went back home to their families.
“But now they are expected to fill out paperwork, attend meetings, speak to health boards be involved with local issues - as well as seeing and treating patients.
“They come in first thing in a morning, and leave well into the evening, that’s the standard now.”
What a GP surgery is like for staff and patients
Emma Ivey is one of the reception staff at the Oakwood Surgery, and after receiving ‘great’ treatment there as a patient she says she was convinced it would be a good and worthwhile place to work.
Among the responsibilities held by the 22-year-old is the booking of appointments, which involves taking basic details of a patient’s condition and passing them through to a doctor.
On the day I visited Emma spoke to approximately 100 patients, some on the phone and some face-to-face,
She said: “It’s quite normal to speak to that many people in a morning, and I think about 98 per cent are later spoken to by a doctor.
“This is the first doctors’ surgery I’ve ever worked at but it does feel very busy, it never really goes quiet.
“Our busiest days are probably Mondays and Fridays, because people have either waited over the weekend to be treated or because they’re trying to get an appointment before the weekend.
“It’s a fantastic job. The doctors here are great, and are really helpful if you ever need to speak to them.
“Sometimes it can be worrying because you never want to make a mistake, but I think it’s worthwhile.
“Part of what I do involves the paperwork for patients, and after a person has been to the hospital there’s often a lot sent in to the surgery about their next appointment and that sort of thing.
“I try to keep on top of it as I go along, otherwise it piles up because so much is sent in every day.
Christina Barker has been a patient with the Oakwood Surgery since 2002, and says she and her family have always received excellent treatment from the doctors there.
“I think it’s a great surgery,” said the 67-year-old.
She added: “I don’t come very often, except for these last few weeks, but when I do come in I can usually get an appointment when I want one, and the doctors all remember me and are very kind.
“All of my family are treated by Dr Eggitt, and it’s nice for us to all see the same person who knows about us and remembers.
“That’s how is should be with a doctor.”