THE FIRST bouquet of pink flowers arrives in Dr Vanessa Doel’s pink surgery at 10.22am. “Dear Vanessa, thank you for all that you are doing for me,” the card reads. “Keep smiling and don’t let the nitwits get you down.”
Dr Doel is touched. “I have a very good relationship with my patients,” she says. “But that’s my downfall. If you’re a popular doctor patients want to go on your list.”
Dr Doel has 6,000 patients at the gleaming new St Alban’s Medical Centre in Bulwell, Nottingham. By common consent this makes her Britain’s busiest GP but, much as it is gratifying to be wanted, it is an endorsement she could do without. This has been her predicament for five months now; she is working 17-hour days, and she knows that she cannot continue to carry three times the work of the average GP. Yet since her partner at the practice went on sick leave in early November (and subsequently retired) she has been unable to find another GP to join her, either as a partner or on a salary.
“If I resign who will look after the patients? If I don’t where does it end? I’ve got this kind of conscience. I really am trapped. I’m exhausted, I’ve just so had it, I can’t carry on like this but maybe the last resort will have to be, sorry, I’m going to have to resign — PCT (Nottingham City Primary Care Trust), John Reid, Tony Blair, sort it out, because if it’s happening here it must be happening in other places as well.”
The Department of Health will tell you that there are 31,000 GPs in the NHS, more than ever before, and that this exceeds its targets. Nottingham City PCT admits it is not meeting its own targets — in a carefully worded statement it says it is short of 12 GPs, though local health professionals believe the shortfall is at least 20, and point out that another ten or more GPs will soon retire. Other institutions — notably the BMA and the Royal College of General Practitioners — claim that the NHS is short of 10,000 GPs.
The reasons for the discrepancy become clear immediately when you spend a day with Dr Doel and see the difference between theory and practice. While the DoH recommends that a GP should spend ten minutes with each patient (and John Reid boasted in January that the average appointment has now grown to 14 minutes) when your patients are drawn from a former mining area and the home of the Player’s tobacco factory where cigarettes are free, a few minutes each can be woefully inadequate. Factor in the DoH’s demand for perpetual computerised feedback on patients and the volume of Dr Doel’s clinical and administrative responsibilities, and it is plain that her commitment to her patients is at odds with the scale of her task. If she asked fewer questions, if she functioned only as a clinician rather than someone who cares, she would be under less pressure but, given that the GP’s task is to prevent as well as to cure, she would be a less effective GP.
June Theaker is an ebullient woman of 70 who is in good health now that Dr Doel has encouraged her to lose weight. Her blood pressure is better, her kidneys are working well but she has a trapped nerve in her neck that makes her wince with pain and stops her sleeping. This can be helped by an injection of local anaesthetic, and following a discussion Dr Doel changes Theaker’s regular medication to one that will suit her better, and which, happily, is cheaper. “You are a gem, ” Dr Doel tells Theaker.
There is a lot of laughter in this surgery, and Theaker appreciates Dr Doel’s easy manner: “This is the first time I’ve got to see you in a year,” Theaker says cheerfully. “I could see the Pope easier. I do feel at ease with you because you take time and you listen and explain.” Dr Doel hasn’t got time, of course, but she makes it, so when Theaker asks about a moving lump in her lip she explains that it is not a worm, or even “what you think it is”, but a blood vessel. “You’re going to live another 30 years, honey.” The appointment lasts for 25 minutes.
Dr Doel’s day begins at 6am. By the time she arrives at the surgery at 8.45am (where she delivers the 224 repeat prescriptions she checked and signed the night before at home, the blood results she acted on, and the wad of mail she dealt with — letters from consultants and other health professionals, insurance medicals, DLA and attendance allowance forms) she has done three emergency home visits and signed a death certificate at an undertakers. She has barely seen her sons of six and four, who were breakfasted and taken to school by her husband, Nick, a former company director who, since December, has also been the practice manager.
“My six-year-old cries because I can’t pick him up from school,” says Dr Doel. “I haven’t stood in the playground. I feel very upset about that. Some weekends we’ve had to come in to do administration. We bring them with us and they play in the car park. My time with my family is compromised, big time. When I started working in Bulwell I was working three days a week, but I was more or less made to go full time because there was nobody else to do it. Perhaps I should go to some leafy suburb where life is easy. I don’t blame other doctors for wanting to do that. It’s extra doctors that I need, not anything else, to offload some of this responsibility for checking everything that happens at the practice. The PCT is aware of my situation and nothing has changed in five months.”
The PCT is also aware that Dr Doel is pregnant. This means that she will have to take time off later this year but will still be liable for the practice. It is an unfeasible set of circumstances to which the PCT responds that it “continues to work with her to explore possible solutions to her current situation”.
Dr Doel is talking as she drives to three further home visits. She is 38 with waist-length blonde hair, pink lipstick, sharp black clothes and a Chrysler Crossfire, and would look like Lady Penelope were it not for the way she engages with people. Everyone she recognises gets an animated wave, and when she sees a patient who looks unwell she stops to urge him to make an appointment to see her. It’s like driving with a youthful Queen Mother who actually does something. Outside the car patients bound across pavements to share their news, and to tell her repeatedly that she is their favourite doctor.
That must be gratifying, but with it comes a feeling that there is no escape from a vast responsibility: many of her patients would rather wait a month to see her than see a locum within two days. That is how she has got by — by employing locums, an expensive and unreliable option in her experience. The average charge is £95 an hour and in February her bill was £13,500. At 2.30pm the doctor due to work tomorrow cancels and Dr Doel sighs that she will again have to do a double surgery, as she did one day last week.
