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Winter in the NHS: A View from Dr Abbie

by Jenny Crane

Today we are sharing a post from Dr Abbie, who is a GP at the Priory Medical Group in Yorkshire.  Abbie has just started her own blog here, and this was her first post.  I found the blog really useful in terms of thinking more about the daily routines and lives of GPs, and how these are shaped by season.  Abbie also raises the important and intricate relationships between family life and NHS work – managing work with a toddler, and also how her views on work have sadly been shaped by bereavement, leaving her a visitor, and a relative, as well as a doctor.

We thank Abbie for letting us share this reflexive, honest, and important piece.  To hear more, you can also follow Abbie on twitter.

I write this first blog post on a Sunday afternoon after my first week back after a much-needed three week break in Australia. 2017 was a challenging year both personally and professionally, I will allude to these difficulties over the upcoming posts.

I usually work three days a week, Wednesday to Friday, with Monday as my day with the little toddler in my life and Tuesday a day to complete work/home admin. I am starting a postgraduate certificate in medical education in the coming weeks and I imagine my Tuesdays will then be taken up with work for this; the biggest challenge I foresee with this will be remembering how to write essays again after a 10 year hiatus! I love having time in the week where I can drop and pick up my daughter from school as I am a firm believer in a happy work/life balance; something that is difficult to maintain but is very important to me.

I started the week on Tuesday doing some ‘overtime’ at the practice. Due to the expectation of an increased workload around Christmas, our local Clinical Commissioning Group (CCG) has funded extra sessions to help cope with demand. These are clinics full of same day appointments. I saw 18 patients during the session, each had a 10 minute slot, and at least 75% of them presented with a cough. Winter is far from over and it will be a tough month ahead as we see more and more ‘winter’ bugs attacking our patients (as well as our staff).

I get asked a lot how I avoid all the viral infections going around in the waiting room. Truth is, I think I’ve had a lot of colds over the past few years so exposure to these infections must provide us healthcare professionals with some kind of immunity (here’s hoping)! From time to time your GP, nurse or receptionist will be unwell and we try hard not to let this impact patient care but, on occasion, a clinic or two will have to be cancelled. I can understand it is frustrating if you’ve waited 3 weeks for an appointment but I promise this is never done lightly, so spare us a thought it this happens….we’ll be in our sick beds feeling guilty the entire time!

I find I’m much more likely to succumb to these nasty infections when I’m run down. So I try to get good sleep (if the toddler allows), rest when I am unwell, eat my greens, drink plenty water (definitely a resolution for the new year for me – more water, less tea!) and keep up with my running when I can to maintain my general fitness. Good hand hygiene is also key, I wash with soap and water if tummy bugs around, otherwise hand gel is quick and easy.

Wednesday was fairly routine day and I will touch more on what a ‘routine’ GP clinic covers in a future blog post as I want to concentrate on the winter challenges this time around. Thursday was a whole day of face-to-face urgent appointments, working alongside our urgent care practitioners (UCPs) and practice nurses. You never know what you’re going to see in these clinics, it can be simple sore throats and rashes to complex abdominal pain, mental health problems or unwell patients requiring admission to hospital. It can be very intense seeing a lot of poorly people one after another so I try to keep a check on the team and make sure everyone’s doing OK. I think it is important that we try to have the occasional caffeine break to set us up for the next batch of patients and to debrief if there have been any tough cases.

During the winter season, the clinics are full of coughs, colds, tummy bugs and flu-like illnesses. I give a lot of self-care advice and would urge patients to see their pharmacist where appropriate prior to seeing us. I understand it can be frustrating to be waiting to see a clinician in our busy clinic only to be told ‘rest, fluids and paracetamol and you should improve in a few days time’…sometimes a chat to your local pharmacist can save you time and the stress of making an appointment. While I’m on the subject of making appointments, if you didn’t know already, a lot of surgeries have the facility for you to book appointments online, which can be so much easier for you.

There are some great resources online where you can get up to date advice, if you are keen on social media there are some great twitter accounts to follow: @valeofyorkCCG is our local commissioning group and posts excellent videos and advice regarding self-care, @NHSengland @NHSchoices and @Patient all post useful health related advice throughout the year. Please comment below if you have any websites or accounts you recommend I look at.

On Friday I spent the morning at our local neurological rehab unit doing a ward round of our patients requiring GP input. Lunchtime was spent doing death certificates and cremation forms, which is a sad but necessary part of our job. The afternoon brought another mixed routine clinic.

It has been a varied week, but so is every week in general practice. So what is it like being a GP in this busy and chaotic winter season? It is relentless. I feel like I’m on a treadmill at work, constantly moving from patient consultations, to visits, to admin and repeat prescriptions. It’s been more difficult to catch up with colleagues and sit down for a cuppa and a chat over our lunch ‘break’. I try my best to take some time out, burnt out GPs are no good to any one.

I feel blessed that I work in a job that I love, yes it is busy and difficult at times, but on the whole it is hugely rewarding. Five years of medical school, two years of foundation training (mostly hospital jobs) and then four years of GP training (including maternity leave for baby no.1) have gone by so fast. It is coming up on 10 years since I graduated medical school and I am in a reflective mood so I can’t finish off my first post of 2018 without looking back at the year just gone and some hopes for the year ahead.

On the 1st March 2017 my dad sadly died after a short battle with sepsis. He spent a week in high dependency unit with all sorts of tubes and lines but he was just too unwell to recover. This was heart-breaking but has also been a learning opportunity for me. Being a ‘visitor/relative’ and not the doctor on the other side of the fence was so so tough. I now have so much more understanding of what bereavement is and how it can affect people’s day to day lives; some days it consumes me, and strangely some days I forget. I expect I will do a specific post on losing my dad when I have the courage/heart.

Anyway, my point being, 2018 is the year that I remember that life is short. I will say ‘yes’ to new experiences and opportunities but I will also learn to say ‘no’ more often. I have come to realise that I can’t do everything and it is important to share the load and take fewer tasks on. I want to be a good GP, but I also need to be a good wife, a good mother but most importantly I need to be the best Abbie I can be and learn to be selfish from time to time. I also hope 2018 brings with it a couple of half marathon medals and some silverware for Liverpool LFC (too much to ask?!?!). Oh and plenty of tea. I love tea.

 

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