As general practitioners the working day is largely determined by the demand from the public for healthcare, and our carefully planned day is never quite as we anticipated. Demand fluctuates with the season, epidemics and health scares. A typical day is hard to define. To be too precise about the working week and clocking off at 5pm calls into question the suitability of a trainee for general practice. Overworking is also bad practice, either form on overenthusiastic trainee or overbearing employer. There are rules on the working week and BMA guidelines in order to protect young doctors from abuse, tiredness, and improved patient safety. This guide is a Deanery viewpoint. Every training practice is different and every trainee has differing educational needs.
"A typical day - Your last patient is booked at 5.30pm and you are looking forward to going home. At 6pm you are convinced they are psychotic. At 6.30pm you speak to the on-call psychiatrist and arrange urgent assessment. You leave for home at 7.30pm."
The Working Week
The working day for a general practice is contractually between the hours of 8.00am and 6.30pm. In addition a practice might offer extended hours (e.g. 6.30 to 9.30pm) and some are open 24 hours a day.
Out of Hours (OOH)
Out of hours is defined as outside the normal day extended hours. A GP registrar is nominally paid for a 40 hours for which he or she gets a basic salary. There is also a 50% supplement on top of the basic pay for out of hours work and to keep their pay in line with hospital colleagues. Out of hours for GP registrars is limited to 4-6 hours a month. Extended hours can include Saturday mornings.
The 48-Hour Working Time Directive
GP registrars are governed by the 48-hour working time directive. This put limits on the working week and should be reflected in the contract of employment. The working week is limited to 48 hours, and the working day to 8 hours. Working includes travelling where it is part of the job, working lunches and job-related training. Working time does not include travelling between home and work, lunch breaks, evening classes or day-release courses. These regulations are based on an average over a 17 week period.
Using the BMA contract as a template training practices can agree the working week with the registrar early in the post to avoid any dispute. The split between clinical, educational, rest periods all need clarification. The Director of GP Postgraduate Education or one of his /her deputies are always willing to offer advice, although it is recommended that the trainer or trainee seeks advice from their BMA employment advisor if there is disagreement with the contract.
Clinical & Educational Sessions
A session is 4 hours and so the working week can be divided into 10 sessions. Seven of these sessions or 28 hours should be undertaking clinical work. Clinical work includes surgery, visits, and administration, practice business meetings.
Three sessions or 12 hours should be devoted to education. Educational sessions include the half-day release, updating the e-portfolio, reading, and protected time for tutorials, practice educational meetings. Educational sessions can include patient contact time for example COTs, attending an outpatient session, sitting with another doctor or clinic.
Outside of term time for the half-day or modular study days the free educational session is an opportunity for the trainee to further gain some competencies. This time can fruitfully be used for an agreed educational plan that could be clinical (e.g. attending an ENT clinic) or educational (e.g. undertaking an audit).
Extended hours do not count towards a registrars OOH commitment. A registrar can undertake extended hours as long as the average day is still 8 hours. This does not usually affect Saturday mornings. Saturday working should be limited to once a month, if more often then time in lieu will be required. At no time should a GP registrar work Saturdays alone without clinical supervision.
Example of a Deanery Approved Timetable
Plus Saturday's 1 in 5 weekends, 9:00 to 13:00, no visits