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For Primary Care| View from the ground

The Joys of Working in a Small Rural Practice

View From the Ground, by Dr Chris Musgrave

I had a great day at work today. I am a GP. Yes, you have read that correctly.  

Dr Chris Musgrave
Dr Chris Musgrave

I am one of the lucky GPs who works in a fully staffed practice. There are four GP partners and a nurse partner. Our doctors are content with their work, and our admin and nursing colleagues feel appreciated. We function well.

My commute to work involves 15 minutes of winding rural Devon lanes, a brief stint on a dual carriageway, and then a meander through town to the practice. It is a pleasant place to be—I always work in the same building, I know all the staff, I know the ‘regular’ patients, and the patients who often require home visits. As doctors here, we can provide continuity of care, a personal touch, and we feel appreciated in our work.

On duty days it feels busy in the morning—taking calls, sorting out tricky administration, and seeing the unwell patients of the day. Things tend to quieten down by the afternoon. Nevertheless, there is always workflow to monitor, prescriptions to sign, visits to attend to. There are also the extra responsibilities of running a small business, including attending to QOF targets and keeping abreast of changing NHS policies.

Our routine surgeries are manageable; we see approximately 15 patients in the morning and 13 patients in the afternoon. Once a fortnight, I do a morning of minor surgery. We are a teaching practice, with medical students, FY2s, and a GP registrar soon to join us.

Generally speaking, I leave work at 18.00 on duty days, and 17.00 on non-duty days. I do not take any work home with me. But why am I writing a piece on working in a small practice, with an emphasis on staff well-being and a manageable GP workload? Because it is fundamentally important to the survival of general practice in the UK. We are facing an unprecedented threat to the GP workforce, with doctors taking retirement early and newly qualified GPs leaving the profession soon after starting. Many are cutting back their sessions. And why the mass exodus? One word, workload. You may think it inconsiderate of me to explain why I like being at a practice with a manageable workload. You may even think me unprofessional (why is he leaving at 17.00, surely he should stay later and do more work?). Essentially, we have recognised the importance of sustainable, manageable working patterns, in providing an environment in which GPs wish to work (and can manage to sustain working in over the long term).

As well as being a doctor, I am also a father of three. I am responsible for childcare on 2 days a week for my 5-year-old, 3-year-old, and 1-year-old. This is not easy work. Many younger GPs have significant caring responsibilities outside their day job. Many more GPs will have other stresses, personal health problems, or responsibilities that may not be obvious. It is no longer acceptable to expect that a GP should be available at work from 8.00 until 20.00. Many simply cannot do this. As professionals, we need to be creating environments that new GPs want to come into, and can manage to stay working in. It is foolish to provide a totally inflexible model of working and expect GPs to ‘like it or lump it’. Far too many are ‘lumping it’, and this has led the profession into crisis.

As for the newly introduced Primary Care Networks, our practice has joined one and we are collaborating with neighbouring practices. However, we absolutely do not wish to merge with other surgeries to create a super-practice covering 30,000 to 50,000 patients. A one-size-fits-all model for general practice would be a disaster, such as a top-down reorganisation of smaller surgeries into super-practices. We have created a practice that works for our staff and patients, in our rural community. This is an environment in which GPs are happy to work. And that is a rarity these days.

Chris Musgrave

GP, Devon