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GPs: What the job is really like

Attacked over pay, waiting times and out-of-hours cover ... what do our GPs have to say for themselves?

By Stephanie Bell

They are just a phone call away when any of our family falls ill. But while a world without our local doctor's surgery is impossible to imagine, the general perception of our GPs is often not the healthiest.

Whether it's complaints from patients about waiting times or headlines highlighting gripes on salaries and hours, it seems our GPs attract their fair share of bad press. It didn't help them earlier this year when a new survey indicated that they would rather strike than return to out-of-hours duty and demand a £20,000 pay rise to work weekends.

The headlines, though, as local GPs have themselves revealed, are far from reality. In fact, during a new agreement with the government on contracts for 2013-14 it was recognised that doctors in general practice in Northern Ireland are, in fact ,work-saturated.

A new survey by the Northern Ireland General Practitioners Committee also reveals that every year our local GPs perform 20 million tests, issue 35 million prescriptions and conduct around 10.5 million consultations between them. There are 1,163 GPs in the province and they look after around 1.8 million people.

The average patient will visit their GP surgery about six times a year, with 78% of people consulting their GP at least once in the last year.

And despite what we think about waiting times and appointments, the survey reveals that 79% of patient consultations are provided on the same or next day, while 98% are provided within five working days. So what do our GPs think? We talked to three local doctors about why they choose their career and what job satisfaction is in it for them.

Dr Tom Black, Londonderry

'My salary from my practice is around £70,000 a year'

The 54-year-old GP is married to Mary who runs her own fashion boutique and they have five grown-up children. He says:

I wanted to be a GP from the age of seven because my own GPs, Dr Peter Fallon and Dr Tom McGinley (founder of Foyle Hospice), were such a big influence on me.

No other area of medicine appealed to me as no other area has the breadth, depth or continuity of involvement in a patient's care as general practice – a fact I recognised in my own experience with my GPs. I studied in UCD in Dublin, which is a great city to live and study in and which was a lot quieter than Belfast in the late Seventies.

I worked in hospitals from 1984 for four years doing most of my clinical attachments in Altnagelvin Hospital, Londonderry.

I did my GP training in Bellaghy with Dr Denis Barker who was a brilliant trainer in that he not only taught me how to perform the clinical job of looking after patients but also how to organise a practice and persuade managers to do the right thing for patient care.

My salary from my GP practice is around £70,000 per year but this varies depending on my outside commitments.

The best part of the job is helping patients sort out problems so that they go out the door in a better shape than they came in.

Hopefully you can give them reassurance that they have nothing to worry about.

Being able to deal with extended families without having to ask who they are or what their history is greatly benefits the patient.

If there is anything I don't like about the job it is the paperwork, bureaucracy and trying to track what is happening to patients through the hospital sector.

The greatest satisfaction is in making sure that all the children in the practice are vaccinated as this is the greatest benefit we can bestow on our patients.

Patients in Northern Ireland are seen more often than anywhere else in the UK and more than twice as often as those in the Republic of Ireland.

The number of GPs stays the same, the access for patients is the best in the world and no matter how many appointments we provide they're all booked and patients want more. It's very tiring being so popular.

About 90% of patients will be seen within 20 minutes of their appointment but always remember the time they were kept waiting.

We tend to allow patients to stay in the consultation until they're finished and this can hold up subsequent patients.

However, if someone is depressed, suicidal, suffering from cancer or suffering from dementia or learning disabilities you really can't rush them out of the room. We deal with three problems on average per 10 minute consultation and if we made the length of the consultation 20 minutes as GPs and patients want, we would then only provide half as many consultations and then the queue to get an appointment would be longer.

GPs don't refuse to do weekends.

All of the out-of-hours work in Northern Ireland is done by GPs and they cover nights and weekends for all patients, seeing on average 600,000 patients per year in addition to the 11 million consultations per year in the daytime work.

When the GP contract meant they had to work day, night and weekend, no-one wanted to be a GP as younger doctors, who are predominantly female, looked to find a post consistent with rearing a family (also true now of young male doctors).

So now GPs have the choice to rota out-of-hours work in addition to their daytime commitment and 40% of GPs do out-of-hours work now.

Older doctors nearing retirement and younger doctors with children tend to stick to the 52 hours a week daytime job."

Dr Carla Devlin, Lisburn

'It's a privilege to improve the quality of people's lives'

The 30-year-old is a Sessional Locum GP and the Northern Ireland Sessional GP Representative. She says:

My interest in medicine came about from a very young age. I am one of three children whose parents were both senior teachers at local grammar schools. My older brother is a GP partner in Montalto Medical Practice, Ballynahinch, and my younger brother is studying for a Masters Degree in Civil Engineering.

I studied at Queen's University and qualified as a doctor in 2006 then completed two years foundation training before beginning General Practice training in 2008. I sat my Royal College of General Practitioners Examination in August 2011 while training in Shankill Road Surgery under the direction of Dr Andrew Nelson.

I work as a self-employed Locum GP. This involves seeing patients every day in a variety of inner city and rural practices across Northern Ireland. I also work in out-of-hours in North and West Urgent Care and Dalriada Urgent Care. My portfolio extends beyond general practice as I am also an Undergraduate tutor at Queen's University Belfast, teaching medical students about good clinical practice and patient care. This is an aspect of my work that I thoroughly enjoy. I am studying for my Masters in Clinical Education and hope to become a qualified GP trainer.

General practice encompasses many different fields of medical practice and this has allowed me to develop a wide range of experience of health related issues. I have completed my diploma in mental health. I am also about to start a diploma in sexual and reproductive healthcare.

It is a challenging and very rewarding career that has given me a lot of job satisfaction. The most rewarding aspect of my job is looking after and caring for the diverse needs of patients and their families. The opportunity to be able to improve the quality of people's lives is something that, as GPs, we are in a privileged position to do.

As a locum GP, I have been very fortunate to work regular sessions in a number of surgeries and therefore have had the opportunity to develop quality doctor-patient relationships and excellent practice team relationships. This is particularly important in the areas of antenatal care, palliative care, and chronic disease management.

The workload of general practice is becoming increasingly difficult to manage for GP partners and Sessional GPs for many reasons – an ageing population, lack of funding and an increase in workload from secondary care to primary care.

A typical day in the life of a GP is very busy with booked and/or open surgeries, telephone triage, signing acute prescriptions, lab result analysis, and making house visits between surgeries.

As GPs, we want general practice to flourish so we can provide more services and even better care for our patients – but we must be given the appropriate resources and funding.

Attracting more investment and appropriate resources into general practice is the way forward in terms of providing the most effective care and management of patients. There are challenging times ahead for general practice. GPs, practice staff, government and indeed patients, need to work together to create a situation where the best level of care can be afforded to all.

Everyone must take individual responsibility for their actions so that our profession is not compromised."

Dr Allen McCullough, Portglenone

'I hate today's red tape and box-ticking culture'

The 47-year-old is a GP in Antrim Health Centre.

He is married to Roisin and they have three children, Matthew (18), Peter (17) and Clodagh (14). He says:

I studied medicine at Queen's University and qualified in 1990. I spent four years in hospital medicine in cardiology and respiratory before training as a GP in Portglenone.

I wanted a better opportunity to see people long term rather than during a brief spell in hospital, which is why I became a GP.

I am self-employed and running a small business with two other partners and so my job does not come with a fixed income. I also perform duties as a deputy forensic medical officer and do out-of-hours work.

For me the best part of the job is getting to know the patients and their families. I have seen patients being born and am now looking after them as adults with their own children.

This lets me get to know them over the years and I can provide continuity of care.

I hate the red tape and box-ticking culture that has been imposed on us over the years.

The most satisfying aspect of being a GP is being able to make a difference to somebody's health and seeing the long-term benefits of the care that I give.

Contrary to what people think about having to wait a long time to be seen by a GP, the evidence shows that we don't have a long waiting list.

There are some who complain that they have to wait but what are they waiting for?

In my practice, anybody who needs to be seen urgently is seen that day. On average 120-150 patients per month do not attend booked appointments in our practice.

This impacts on the number of available appointments.

Patients have to respect what issues the person in front of them has. Every patient has to be seen and given due care and attention.

Many patients have multiple issues to deal with per visit and 10 minutes sometimes just isn't long enough to deal with this. I will not tell a patient that their time is up and they have to leave.

GPs don't refuse to work weekends. GPs do work in the out of hours service. I do four to five on-call shifts in the out-of-hours service per month, plus one in four nights as deputy forensic medical officer.

Doctors: facts and figures

As well as a degree in medicine, GPs also need to pass a two-year foundation programme of general training as well as specialist training in general practice.

GPs can work 52 hours a week, including evenings and weekends. They may also be on a rota for out-of-hours emergency work.

Doctors on the Foundation Programme can earn between £22,412-£31,434 a year. Doctors doing vocational general practitioner training can earn between £29,705 and £46,708 a year.

Full-time GP salaries can be between £53,781 and £81,158 a year, n Salaries for doctors in training include an additional amount based on the average hours of overtime worked and time spent covering unsocial hours

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