"Headline it for me." As a GP, this is a stock phrase I use if you come in to my surgery and say you have four problems to discuss. At least you have given me a heads up that there are four problems, but now I want a list of one-word titles so I can judge what I can manage in the time.
Literally everyone expresses amazement when I reveal appointments are scheduled to last 10 minutes only. Apparently, this is a very well-kept NHS secret. I can talk to you about anything you like for 10 minutes: hair loss, mood problems, toe nails…. If you walk in with a limp, or a red eye then I know early on what we are going to be talking about. Sometimes I am kept in breathless suspense: "I’ve had this problem for more than two weeks, and I’m really worried about it as it’s so painful, my mum said I should definitely come and talk to you about it…" So what is it? What are we talking about? It could be anywhere in the body until the roulette ball falls.
Of course I see the lip curling annoyance when I say, after nine minutes spent discussing something else, that the heartburn, tiredness or aching knee you're also experiencing are "a whole other problem. I would be rushing you if I tried to do it today, and I wouldn’t be able to do it properly."
It’s a drag for the patient to have to come back another day, book another appointment, wait again in the waiting room and I experience the time pressure the other way around when I see my own GP. I always pick the oldest GPs; I am not looking for a good bedside manner, I want their experience. But even I was a bit surprised at my own doctor’s brusque opening gambit. As I stepped into the room, he introduced himself, and as I walked across the room he checked my name. By the time I was seated he had already asked, "How can I help today?"
I laughed at the time, but now I do the same thing and save 30 seconds which is, after all, 5 per cent of our allocated consultation time.
I strain to keep to time. Every extra five minutes spent on one person’s appointment accumulates. You, my last patient, end up waiting 30 minutes or more.
As a doctor, I can cope with a life of 10 minute appointments because I do not work full time. I can manage my work with this level of intensity, and have room for the work I miss out on to slop over into the afternoon (for which, of course, I am not paid). I have also taught myself to touch type, which gives me an edge over other doctors.
All of GP training is geared to the 10 min appointment, but new registrars have to be weaned down to this level of case work slowly. They start at 30 minutes per patient and really enjoy the work. They are then cut down to 20 minutes, and then 15. Usually they spend quite a while at 15 minutes getting used to the work before they are finally ratcheted down to 10 min and their morning’s patients are built up to 15 or 18 and then they realise why everyone else has been looking less relaxed than them.
I am now so used to working this way that it surprises me to even question the idea. That there could be a world of 15 min consultations seems strange, luxurious and totally out of the question. Yet if the UK really cares about its health care staff and genuinely respects them it should not be depending on the charity of its workers for the system to run properly. And it's not just GPs like me who are expected to work like this.
The ratio of doctors to patients in this country is low (2.8 per 1000 patients, compared to a European average of 3.0), but of more concern is the ratio of nurses to patients. Of all the groups in the country why is the NHS relying on the charity and goodwill of nurses in order to run? They are being expected to work in circumstances where they cannot do their work safely and properly and then expected to work overtime as well.
To put a nurse to work in a ward which is not properly staffed is nauseating. The minimal number of nurses left to work on a ward of 24 elderly patients with a 99 per cent bed occupancy rate should be at least six. Four nurses for a ward of this size (as has recently been reported by Unison) is simply not enough. Those nurses wishing to care for patients with kindness and dignity are forced to work in a place where this is physically not possible. They must complete ordinary care such as washing, toileting, feeding, then they must address medical issues such as dressings, temperatures, medication and only then might they find the time to notice – or, worse, to not notice – that one patient's condition has deteriorated.
The government and the public complacently call healthcare workers heroes and yet continues to expect them to work in these circumstances. I am not a hero. I have been carefully trained for the job I carry out and I have accrued experience in doing so. And I try to be kind, always. But I am well aware that the government uses that interest, and my professionalism, to pay for eight hours of my work and receive 12. Every extra five or 10 – or even 20 – minutes spent with a patient is our personal, charitable gift to you and to the government. The majority of nurses, meanwhile, work an additional six hours each unpaid every week. They never get that time back.
I am prepared to continue my 10 minute appointment schedule in general practice. I’ve done it for 15 years and I’ll probably do it for my remaining 20. Like an old timer in a prison cell, I can’t imagine life any other way. It's not right, but I’m used to it. The idea of the government paying for 50 per cent more consultation time is never going to happen.
Yet there’s something materially different from me having a long day seeing extra patients, to patients daily stuck in their own urine in a hospital bed and no one having the time to care for them.
I want to spell this out: the government is running the NHS on the good will, free time and charity of its healthcare workers and its morally wrong to keep on asking for that. No one minds a one-off push when times are tough; what we mind is that casual assumption that unpaid work is essential to patient safety. Nurses are essential to healthcare and do the hardest job of us all. Why are they being used like this?
Are we going to continue to slap people on the back and call them heroes or should we fork out the cash and up the staffing levels for the healthcare workers that all of us need?
Berenice Langdon is a GP working in South London
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