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What Does a NHS GP Do?

The National Health Service (NHS) is the health care system of the United Kingdom. It was formed in 1948 and is the world’s largest publicly funded health service. All medical treatment is free, regardless of income or wealth. (There are some flat rate prescriptions charges for some people). Funding comes directly from the government Department of Health, via taxation. Health care provided is from ‘cradle to grave’.

General medical practitioners (GPs) are part of the NHS. They are based in community clinics called GP ‘practices’ or ‘surgeries’.  To qualify as a GP, after 5 years at medical school, a further 5 years postgraduate training is required. This is composed of rotating posts in hospital and General Practice. After passing the rigorous postgraduate examinations, the doctor becomes a Member of the Royal College of General Practitioners (MRCGP). In the UK a GP is a specialist in community primary care medicine. GPs are trained to assess the psycho-social and biological aspects of patient care, providing holistic care. We aim to deliver a ‘patient centered’ approach. Excellent communication skills are essential tools for our work. We are the medical ‘all rounders’, we deal with all patients, any age, any background, any problem. We are the first port of call. Often referred  to as the ‘gatekeepers’ of the NHS.

Many GPs develop more specialized areas of interest eg. palliative/terminal care, dermatology, family planning or minor surgery. The choice is endless. This primary care model of care has been refined over many years and we are proud to have one of the best systems in the world.

When qualified the GP then usually joins a group of GPs in a community health center or ‘surgery’. A GP can work as a self employed Partner, Salaried GP or a locum. They can work full or part time, depending on their ‘work-life’ balance. The hours are generally ‘family friendly’.

In my practice there are 6 GP Partners and 1 GP Registrar (doctor training to be a GP). We have a list of 9000 patients in our catchment area. We work closely with our practice nurses, receptionists, practice manager, midwives, health visitors, district nurses (visit patients at home), social workers, physiotherapists, chiropodists, phlebotomists, counselors, pharmacists, community matron and care coordinators. This is known as the multi-disciplinary primary care team. The GPs work as part of this important team to deliver optimal patient care. The GP partners are also responsible for the business/financial management of the practice.

All of our medical records, appointments systems and prescribing of medications are fully computer based. Most of the referrals we make are completed online. We even send out messages and appointment reminders via mobile phone texts.

My normal working day starts at 8.30am. I see about 18 patients, each appointment is only for 10 minutes per person. Afterwards I take advice calls on the phone from patients. Between 1-3pm, I attend patients at home for visits. These are for elderly or nursing home patients, who are unable to travel to the practice. At 4pm, I start the evening clinic, seeing 14 patients. There is also alot of paperwork and administrative tasks to complete eg. reviewing blood tests and investigation results, sending referral letters, checking various intrays. Having excellent time management skills is essential, I prefer the ‘one touch’ technique. Eg. make a decision, complete a task and move on, don’t keep on thinking about a task again and again.  Also during the week there are many meetings to squeeze in, together with a weekly baby check and immunizations clinic.

We are able to diagnose and treat a wide range of medical issues in the practice. Occasionally if patients are acutely unwell we are able to admit them to the local hospitals for inpatient care. We also can refer patients to specialist out patient clinics for further care. The specialist will require a GP referral letter before the patient is seen, even if it is a fee paying private referral. This is because the GP is ultimately responsible for the patient’s care. This provides an ongoing continuation of care. Many patients will remain registered with their usual GP for their lifetime. Many chronic medical conditions eg. diabetes, mental illness, heart failure are now managed in the primary care community setting. This is because hospital based care is very expensive.

My interests include medical education. I teach medical students from the University of Nottingham and train junior doctors, GP registrars. This is an extremely rewarding part of my occupation. We are actively involved in audits and research projects.

During the nights (after 6.30pm) and weekends the ‘out of hours’ GPs take over looking after our patients. This is based at another local health center, with GPs doing shifts.

Our practice also runs a monthly ‘patient participation group’. About 25 patients attend these meetings to discuss a variety of health issues. This group has proved to be an enormous success. Making  the relationship between patients and the practice stronger.

I would encourage the Medical colleges in Pakistan to develop their Primary Care/ Family Medicine model, as it will be a cost effective method of providing basic healthcare to a large population. For the masses there is definitely a role for the ‘all rounder’ general primary care physician.

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