Work Pattern Back as it was Before.

I was really nervous this morning before work. And yesterday in anticipation of today.

My first on call session since returning 2 months ago.

Work has been going OK on the whole and I’ve gradually got back up to my 6 sessions (3 full days in effect). Things are much the same as previously in many ways! I was supposed to learn new techniques to manage the load (especially emotionally) better but that is easier said than done! (Still haven’t been brave enough to publish the blog about this.) There are subtle things I am trying but that isn’t always going that well. I instinctively throw myself full pelt into everything and this isn’t easy to change. The only time I can think of since being back when I tried not to just say yes to everything went a bit wrong; I’d already spent over double time dealing with a complex unwell patient who then requested new medications that they weren’t completely sure of and weren’t on repeat so I asked them to write it down and leave a list with reception for me to do once I’d finished the morning session. Apparently, this caused grumbles because I didn’t do it there and then (I knew it would take an extra 4-5 minutes which wouldn’t have been fair on the patients who had already been made to wait longer by this patient). I found this very frustrating and upsetting having spent so long thoroughly doing the rest of the consultation. Hard to make the changes when it feels it is just going to backfire on me.

So…..I still throw myself in. I still give my all. I still spend the time patients need. I therefore still run late. I therefore am still plodding through workload nearly 12 hours later.

So, when it came to the on call session, I doubted my ability to manage it well. Before I went off, the sessions would be so full that I would still be doing on call work when I should have been starting my afternoon clinic. There is no limit to the amount of work that comes in; you just have to keep going and deal with it. And it’s getting worse and worse as the pressure on the NHS system is rising week on week. Literally. Everything that can’t be slotted into the appointment system in the desired way is put to the on call team. The appointment system is so crammed full and with long waits now that a huge number of people end up being put through this way instead as they don’t feel they can wait for the next available appointment. I have seen my colleagues recently trying to get through an astounding amount of work in half days on call. It can be 50+ phonecalls followed by trying to slot the patients that need seeing in to the last few emergency appointment slots. But they don’t go far. So they have to see the patients themselves. And do extra visits as everybody else already has too many. Then there’s the calls from hospital colleagues and paramedics. Urgent prescriptions. Abnormal results phoned through. And so on. Thank goodness for the support of our wonderful Nurse Practitioners who share a great deal of the load; we’d be completely overwhelmed without them. And we’re a good supportive team that try and muck in and help each other out when we can.

There’s quite an art to managing the triage system; you have to make a judgement over the phone as to whether you can (hopefully) deal with this straight away on the phone or if they need to be seen, how quickly they need to be seen, where on earth you are going to find a slot to put them into etc. It’s a skill based on probabilities and risk assessments and is getting much harder to do safely and appropriately as the system can’t accommodate the increasing load. You look down the list to see what sort of things are coming up and trying to decide how you might need to allocate the few remaining appointments. Then more and more phonecall requests pile on faster than you can get through them.

My turn today. I desperately hoped, at least for this first one, that it wouldn’t be horrendous. I’m really pretty exhausted at the moment; sorting out the youngest’s birthday, both boys seem to be waking in the night or earlier than usual then there’s been other things making life busy and stressful. So, I just didn’t feel I had the energy to manage a really full-on on call session today.

It was an odd one; lots of things that were difficult to sort out, but thankfully not massive numbers of calls otherwise I would have been doing it all day! Rather fortuitously, I had a rare but highly valued admin session in the afternoon (maybe it was planned deliberately – I don’t know!). Just as well, as I didn’t finish the morning’s work (that officially finishes at 1pm) until 2.30pm! We did completely run out of appointments quite early on so I did end up bringing people straight in to see me. But it was OK. I just slotted back into the old rhythm of doing it and got on with it without a second thought in the end. Aided by tea….lots of tea! (And a bit of chocolate!)

Life is feeling much like it did before September now in many ways; there is so much work to get through that the days are long. I am so exhausted and brain dead by the evenings when I get home that I am fairly useless (like before!) so I am falling behind again on things that need doing (but now at least I have Thursdays to catch up a bit). I know I have to be careful ongoing to ‘self-care’ in all aspects of my life. As mentioned at the beginning, there are strategies that I need to consciously develop somehow; some I like the idea of trying to instigate and some I am not sure are really ‘me.’

The work pattern is back as it was before. So far it is OK. Will it be ongoing? I don’t know yet…there’s a balance to be struck somehow.

P.S. I don’t have a messy desk like the blog image!