FAMILY doctors have not had it easy in the last couple of years, with accusations that they earn too much and work too little. Soaring wage bills as a result of their 2004 contract, which also allowed GPs to opt out of working antisocial hours, have led to some asking whether the taxpayer is getting their money's worth.
The situation was made worse last week when an Audit Scotland report said GPs were getting paid so much that there was little incentive for them to work out-of-hours, even with pay of up to £150 an hour.
But, after spending a day in a busy GP sur
gery, it is easy to see why doctors are upset with the suggestion that they are only working part-time.
For Dr John Garner, a GP in Edinburgh, a working day lasting more than ten hours is not uncommon. He arrives at his surgery in the north-east of the city at 7:45am. He boots up his PC and immediately faces a long list of the tasks he needs to cram into the day.
Many would find it daunting, but after 28 years in general practice - all at the same surgery - Garner appears relaxed, despite not quite knowing exactly what is coming through the door.
"The nice thing about general practice is the variety," he says. "You never know what the day will hold."
The waiting room of the St Triduanas practice quickly starts to fill, patients staring nervously at the person coughing beside them, waiting to be called into the consulting room. Garner's room is a similar jumble to that repeated in surgeries across Scotland - a bookshelf crammed with the latest NHS missives and medical journals, stuffed toys to appease crying children and the usual medical paraphernalia.
Pictures of polar bears adorn the walls - perhaps the result of some research in the Lancet suggesting that the sight of icebergs helps relax nervous patients. But most seem oblivious to the snow-lined landscapes as the appointments start at 8:30am sharp.
The first patient has a common problem - high blood pressure and high cholesterol. Garner taps a couple of keys on his computer and up pops a risk calculator, allowing him to enter a few details to estimate the patient's risk of heart problems. He says that by taking a statin - a cholesterol lowering drug - the patient can reduce the risk of a stroke or heart attack from 23 per cent in the next ten years to 15 per cent. The patient is given a prescription for a new blood pressure drug with a view to starting on statins in the future.
The morning presents the typical variety of consultations Garner faces on a daily basis. A man who suffered a fall reports back and hip pain. After jumping up on the doctor's couch for a quick examination, he is sent away with advice to increase his painkillers.
Next comes a young woman who has just returned from holiday with a nasty asthmatic wheeze, who is given a course of steroids to see of the problem.
Next comes a mother with her 11-year-old who has developed a mysterious rash. Garner admits he does not know what it is, but is confident it is nothing sinister. The young patient is told he can have the day off school, but to get straight back once it has cleared up. Garner manages to see 12 patients in two and a half hours, dispensing advice, prescriptions and sick notes.
"Some patients think there is a magic pill for their condition," he says. "Sadly there isn't always. Sometimes we have to say we do not have the answer, but we do all we can possibly do for them. Sometimes they just have to help themselves."
Garner, 56, says things have changed significantly in the time he has been a GP.
"We have gone from being matriarchs saying 'this is what you will do', to being educators saying 'this is what you could do'. Some of the older patients don't like that. They want to be told what to do."
He says a lot of the work of a GP is reassurance: "There is a lot of anxiety out there and 'take it to the doctor syndrome'. We are sometimes just there to reassure people."
After entering his notes about his morning patients into the computer, it is time to head out on home visits. Each of the six practice partners take a share of the daily visits. Today, Garner has two patients to see.
The first is an elderly woman living on her own. Garner is keen to check her bandaged leg, but he is also there in advance of a meeting with social services to discuss how she is coping. Her house is chaotic. Papers, food wrappers and clothes are piled all around her. After assessing her leg, Garner tells her about the meeting with social services. He asks if she has considered residential care. But she is determined to live independently as long as she can.
Next is a visit to two elderly sisters who live together. One is having bowel problems and Garner suggests a change of medication that she happily accepts. As he goes to leave, he is told a gift awaits him outside the back door - a large plant for his garden. After saying thank you and good bye, Garner heads off, buying a sandwich on the way back to the surgery.
"We are in a unique position to people watch," he says. "I find people fascinating. It is nice when you have worked in one place for a long time that people know you. "They'll say 'you treated my mother when she was ill'. You build up a good rapport with them."
Lunchtime is not spent relaxing over a newspaper or strolling around the shops: Garner joins other members of the practice for a weekly meeting where they discuss issues affecting the practice.
They eat lunch while discussing complex patients and other the possible introduction of a computerised system for organising home visits.
It is then straight into afternoon surgery - another line of patients to get through. But Garner seems to relish his job. Each patient is another problem to solve, another life to improve.
"Medicine is not just a science. It is an art," he says. "It's about building up relationships so that you know when you can be cheeky to someone. It's about giving people confidence and reassurance." The afternoon patients' conditions are as varied as those he saw in the morning. There are more back pains, more knee complaints as well as panic attacks and alcohol problems to deal with. And Garner says this is a relatively simple.
General practice has seen great change: the new contract saw a range of performance-based targets for GPs, as well as the option to choose not to provide out-of-hours cover: something most GPs jumped at. But Garner says it has also helped patients.
"The new contract has helped us be more efficient in managing chronic disease, because it has focussed attention on these issues and guided us in how to treat them. It has improved patient care, there is no doubt. It has also improved the lives of doctors."
But suggestions by the new Scottish government could see GPs being urged to take a more flexible approach to their practice.
Nicola Sturgeon, the health secretary, has said she wants to open discussions with doctors about offering appointments at times to suit working people. But while Garner can sympathise with this view, he is unsure if it will be possible.
"I think it will be difficult. We are already doing a nine to five day. I come in at 7:45 and do not leave until 6:30. That is about my limit. To change that would be difficult and costly, in terms of having the other support staff in at different times.
"I can understand why this is an issue, but the proportion of the population who would want to visit in the evenings and weekends is quite small. Most of the people who come to see us are elderly or very young. They are very happy to come in the hours that we are open at 8am to 6pm is quite adequate. We used to open on a Saturday, but were only seeing two or three patients. It was not the best use of our resources."
Garner turns to finish his paper work - or more accurately computer work. Technology has seen the demise of paper records behind the reception desk. He doesn't leave until 6:30pm.
