AS it's reported fewer doctors are deciding to go into general practice, York GP Dr John Lethem outlines a typical day in his life and the impact of significant change in the NHS.

It’s 8.30 on Monday morning, the start of my working week as a GP in York and despite it being incredibly demanding and often exhausting, I still look forward to it. I’m in my 26th year of general practice, and while much has changed, the basic core work and values of caring remain.

I’ve been in the same practice since I started in 1989 – although our name’s now changed to Unity Health. We foster the idea that we’re all equally important in the work of patient-care; from the health care assistant to the nurse team manager, from the receptionists to the practice manager, we all rely on each other and the patients rely on us.

When I started I was the “young” Dr Lethem as my Father was in the practice before me. We had three surgeries each with about 2000 patients, four GP partners, two practice nurses, several receptionists and a practice manager. Not a computer in sight to start with, no mobile phones or even pagers, no printers or fax machines.

Now we have two of the same surgeries plus a newer building to serve over 23,000 patients; a number that’s ever increasing. The size of our team has risen accordingly to 40 members, with certain staff members involved entirely with scanning and coding of incoming records and letters.

We have “IT” galore and have to keep moving fast to keep up with developments. We now email some of our patients as well as texting them with their appointment times, and are just about to start offering “skype” and internet consultations.

Over the years, patient demand has increased significantly – especially from an ageing society and those needing more complex care - leading to general practice facing a workload crisis.

To cope with this, our fantastic team of practice nurses now manage long-term conditions including asthma, diabetes, and chronic kidney disease, as well as being involved in travel medicine and family planning work. All these areas are so much busier and involved now as we can do so much more with better monitoring and a wealth of new medications and treatments.

As a result of this, my own work has changed to more of an over-seeing role in patients with these long-term conditions, managing the complex cases in particular when someone has several co-existing conditions. This involves a balancing act with medication as there are often risks and side effects.

Although when we started, appointments used to be six minutes long, we now have ten minute appointments that are rarely long enough; there’s often not enough time to talk with our patients as much as we or they would like to, to get all the relevant information entered into the computer medical records and order further tests or make referrals.

There’s a tremendous amount of “paperwork”, now “computer-work” to be done after the face to face surgeries and sometimes my mornings can run on to 2pm before I’ve cleared everything.

The truth is though that with the increasing demand and diminishing resources, GPs are forever running out of time, out of space, and out of energy; a concern repeatedly raised by the British Medical Association which is calling for the long-term, sustainable investment needed in GPs, practice staff and premises so we can deliver the care our patients deserve.

I’m also seeing an increasing number of patients with mental health issues – something for which a ten minute appointment just isn’t enough. These patients need more time, support and understanding. We serve the student population at York University, and unfortunately it’s not unusual for severe mental illness to become apparent during their student course.

There is great distress of course for the student and also those around him or her, as well as for parents who may be living a long way away. We would very much like to see local improvements in our mental health services, particularly for Eating Disorders, Autistic Spectrum Disorder and Adult ADHD to name but a few.

So much has changed but the very important role of the GP remains. We listen to and deal with our patients’ hopes and fears, illnesses and pain. We try to reassure when we can, keep them healthy where possible and deal with the consequences of disease as and when it occurs. A rewarding but often exhausting day’s work.

My Daughter, Claudia is currently studying medicine. Hopefully a third-generation Dr Lethem but I’m not sure whether she will want to be a GP.