General practitioner Practice manager England Wales

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Urgent prescription GP case studies

GPs in crisis
Doctors around the country share their stories about the day-to-day challenges of working in general practice

GPs in crisis

Doctors around the country share their stories about the day\-to\-day challenges of working in general practice

KickerThis is a kicker.

**Gerry McCabe is a former GP partner from Hertford. After 15 years, at the age of 45, he resigned from his partnership due to an unsustainable workload.** When I became a GP partner in Hertford in 2000, a typical working day was manageable and enjoyable. Our practice would see patients from 8.30am to 5.30pm; wed have an average of 30 face\-to\-face consultations with far more time to care for patients; wed have between five and 10 GP phone calls a day, and wed eat lunch with colleagues.

No matter how late I worked into the nights or weekends, I never seemed to catch up.

For the last few years, however, the pressure and workload have increased, both from patient contact and more significantly from behind\-the\-scenes paperwork. This meant I was unable to complete one task before the next one was due, and no matter how late I worked into the nights or weekends, I never seemed to catch up. I maintained this relentless pressure for four years until I recognised the early signs of burnout, and saw no alternative but to resign from my practice in order to restore my work\-life balance.

I saw no alternative but to resign from my practice in order to restore my work\-life balance.

Since then I have been enjoying working as a locum. However, I shall shortly be moving permanently overseas as I see this as the best option for the remainder of my career in general practice.


Over one third of GP partners are considering closing their lists to safely manage workload, [according to our survey](\-voice/influence/key\-negotiations/training\-and\-workforce/urgent\-prescription\-for\-general\-practice/key\-issues\-survey)

**Helena McKeown is a GP partner in Wiltshire and mother to two daughters. Despite extending appointment times to 15 minutes, the demand at Helenas practice still means GPs never have enough time for each patient's needs.** Its 7am and Im on my way to work. On most mornings, our appointment list is full. When I am finished with one patient, another is ready to see me. I start work earlier and finish later than required in order to extend my appointments from 10 minutes to 15, but its still difficult to do everything required in that time.

When I am finished with one patient, another is ready to see me

By 11am Ive seen 11 patients, contacted specialists to discuss two complex cases, signed urgent prescriptions and examined blood results. I jump in my car to visit the local nursing home, and then a terminally ill patient. By the time I get back, it is evening surgery, which I carry into extended hours. Its close to my kids bedtime and I just want to get home. Last year one of my longstanding partners left to work in a rural practice where the workload was less stressful. We advertised for a replacement partner, but due to recruitment issues in the local area, just one person applied. They were the perfect applicant and we offered them the job, but sadly they declined in order to take a better\-paid post.

We will have lost four out of seven GP partners in the past 18 months.

In the end, we offered the post to a GP trainee who only wanted to become a salaried GP rather than a partner due to the added pressures of running a practice. Worryingly, over this coming year, three GPs will be retiring. That means we will have lost four out of seven partners in the past 18 months. At the same time, we have a salaried doctor on long\-term sick leave with an acute injury, and may soon face a situation where we dont have enough doctors for the number of patients walking through the door.


Nearly 85% of GP practices in England report that excessive [workload is preventing safe delivery of patient care](\-voice/influence/key\-negotiations/training\-and\-workforce/urgent\-prescription\-for\-general\-practice/key\-issues\-survey)

**Ian Hume is a GP partner in Diss, Norfolk. Balancing his workload to better serve his patients is getting more difficult.** Arriving for an 8.30am start, I have a busy morning seeing between 18 and 24 patients, and I grab a coffee while looking over the requests for home visits with my colleagues. I often have an additional 10 phone consultations throughout the day as well. Morning surgery finishes at 1pm, with afternoon surgery starting at 3pm. This gives us two hours to do home visits, attend a nursing home and make telephone calls, leaving no leeway for complications or delays.

I start at 8.30am and finish at 8.30pm another fairly typical 12\-hour day

The patients I visit are all in their 80s and find communication difficult. This makes each appointment longer than the time available. My visiting schedule quickly slips, and I have to grab lunch from the petrol station before returning to the surgery for my afternoon appointments. I work from 3pm till 6pm, seeing another 15 patients in that time. On average, paperwork takes about two hours a day, following up test results and checking new mail, dealing with tasks and messages. I finish around 8.30pm another fairly typical 12\-hour day.


Our campaign, [Urgent Prescription for General Practice](\-voice/influence/key\-negotiations/training\-and\-workforce/urgent\-prescription\-for\-general\-practice), aims to shine a light on the issues facing GPs. Follow the campaign on [Facebook]( and [Twitter]( using [#GPincrisis]( Read practical advice on how to manage your workload with our [Quality First web portal](\-practices/quality\-first)

**Credits** **Digital content producer:** Jackie Mehlmann\-Wicks and Sarah Quinlan **Email editor:** Lisa Hansson **Senior digital content producer:** Karen Lobban **Senior media officer:** Eloise Henderson **Senior production editor:** Kelly Spring With thanks to the GPs who contributed their stories.


Not a member? Find out what the BMA can do for you: [\-us](\-us)


The issues we aim to address are a harsh reality for GPs working on the front line of primary care. Below, real life doctors share the everyday challenges they face to deliver the care their patients deserve.

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Stories of GPs in crisis

Shonagh Speed-Andrews, a GP in Cumbria, describes how a shortage of locum cover makes it difficult to take annual leave:


A crisis of supply and demand

"At our practice, the big problem we're facing is the struggle in finding GPs that want to work in Boston."

Read the case study


Not enough hours in the day

"I am incredibly grateful to work as a GP. It is a real privilege to care for fantastic patients in Hertfordshire, but it's time to face reality."

Read the case study


Juggling priorities and complex needs

"This morning's diabetic clinic had a list of 32 patients. I had already spent over an hour vetting the clinic to select patients who were suitable to see the nurse and those who should see the GP."

Read the case study


Wheelchair access is limited

"Put simply, our premises - which are around 40 years old - are not fit for purpose."

Read the case study


Forced to reduce some services

"Our surgery is full to bursting, with the practice manager and secretary working out of a portakabin, but our patient list is still increasing."

Read the case study


Forced to hot desk to an absurd degree

"My practice has been based in a three-bedroom terraced house since before the inception of the NHS and we now see over 7,000 patients."

Read case study


Please note these case studies formed part of previous BMA work on the issue of general practice service provision and practice premises.