This site is intended for health professionals only

The changes and challenges of GP life

22 June 2009

Share this article

BA (Hons) Business Studies

Practice Manager
Hunter Family Practice, Craigavon, Northern Ireland

Lorraine “retired” after a long career in the army in 2003. Having worked primarily as a trainer, she latterly retrained to take on the post of Regimental Accountant. She took up her current post in the same year. Outside of work, Lorraine enjoys walking with her cocker spaniel Meg, and spending time with her grandsons Oliver and Alexander

When the NHS was introduced almost 61 years ago, its intention was to make the same level of service freely available to everyone – although one could argue that the “postcode lottery” in certain areas of healthcare has overturned that laudable aim.

Primary care has evolved and has seen considerable change over the years. I can remember (not 61 years ago, I hasten to add!) when my GP worked from home, with the only staff standing between him and patient demand being his long-suffering wife! There was no appointment system – everyone just turned up, and surgery ended when the last patient had been seen.

How different things are today, with fixed surgery times, pre-booked appointments, purpose-built surgeries and staff ranging from practice managers to healthcare assistants. There is also an out-of-hours centre to deal with patients requiring advice or treatment outside normal working hours, and we have protected learning time, so that we can train together as teams.

General practice is constantly changing. I started in September 2003, during the lead-in to the new General Medical Services (GMS) contract, with no previous NHS experience whatsoever. This was a steep learning curve for me. No one told me that the manager of a small family practice is responsible for absolutely everything – personnel, accounts, staff training, planning and organising clinics, ensuring that Quality and Outcomes Framework (QOF) points are maximised (like Anne Crandles in the last issue of MiP, I too am a sufferer of “QOF Fever”) and even manning reception if we are short-staffed.

There are no “departments” in general practice. My daughters, who laugh at my inability to master the functions of the many buttons on the TV remote, would be amazed to find that I am the “fixer” of frozen computers, jammed printers, or programmes that the GPs can’t get to behave as they should! Anyone who has listened as often as I have to a clinical system supplier’s taped message (“your call is important to us …”) will understand the powerful incentive I had to improve my skills in this area!

I have seen many advances in my short time in general practice. We have become paper-light – though the number of emails I have to read daily makes me wonder. Hospital letters are now scanned to patient notes. Lab results, patient registrations, changes and closures are managed electronically. We have self check-in and a visual patient call system. GPs have handheld personal digital assistants (PDAs) for house calls and, best of all, we seldom handle charts except when summarising new patient notes.

How then has all this not reduced staff workload? Clinicians complain about the length of time spent during a consultation recording everything required for the QOF or for a directed enhanced service. Admin staff say the scanning, Read coding and the number of letters inviting patients to clinics are endless.

Nevertheless, the team provides an excellent service to our patients, and we get a real buzz when we feel we have done something to make a difference to somebody. We look forward to new challenges as primary care continues to change.