What actually happens behind the reception desk.
An honest account of a working day in English general practice, written by a clinician working across three surgeries. Why clinics run late, why the waiting room can look empty while everyone is flat out, and why some requests get sent back.
A day in one clinician's chair
A typical day, pieced together from real ones. Some of it patients see. Much more of it happens out of sight.
The overnight pile
Log in to find what has arrived since yesterday: NHS 111 outcomes that need clinical review, out-of-hours reports, hospital discharge summaries and clinic letters.
Phones open and online requests arrive
The 8am phone queue starts, and online requests (through AccuRx) arrive at the same time. Each one is read and sent to the right person, which isn't always a GP.
20 appointments, 10 minutes each
Call the patient, listen, examine, explain, prescribe or refer, and write it all up in the record. Ten minutes covers all of it.
The invisible workload
Prescriptions to sign. Test results to review and act on. Hospital letters and discharge summaries to read and action. Tasks from colleagues, referrals to write, and phone calls to the hospital to agree a plan.
Lunch, somewhere
Clinicians need food too. But the midday gap is also when the morning's overrun gets caught up, urgent call-backs get made and the next batch of results lands. Lunch has to fit around all of that, and it can't be eaten at the desk: infection prevention and control rules don't allow food in clinic rooms, so eating means stepping away from the work entirely.
21 more appointments
The same again, often while still catching up on the morning's overrun.
Finishing what's left
Results, letters and prescriptions that couldn't be done between patients still need doing today. None of them can wait, because there may be an abnormal result in the pile.
One clinician. One day.
Every item here is something a qualified clinician has to read, decide on and take responsibility for.
Why clinics run late
Nobody plans to run late. These are the three most common causes in our practices, and each one comes down to doing the job properly rather than quickly.
“While I'm here…”
A 10-minute appointment is designed for one problem. Three problems in one slot means each gets about three minutes, or the slot stretches and everyone after waits longer.
No interpreter booked
If a patient needs an interpreter and one wasn't booked, the consultation can't be done safely in 10 minutes, and sometimes can't be done at all. Interpreting roughly doubles the time needed.
Complex needs, short slot
Someone with several long-term conditions and multiple medicines in a 10-minute slot. The clinician won't cut corners on safety, so the clock gives way.
The 10-minute maths
See how one appointment affects everyone booked after it. Change the settings to see the knock-on delay.
Illustrative model, not a measurement: about 8 extra minutes per additional problem, interpreting doubles the time, and arranging an unbooked interpreter adds about 10 minutes.
Knock-on effect on the clinic
Why we sometimes say no
When a practice sends a request back, it isn't us being awkward. It's about clinical responsibility: whoever makes a decision should see it through. Work we take on that belongs elsewhere comes out of appointments for our own patients.
The hospital said my GP would prescribe it
If a hospital specialist sees you in clinic and decides you need a new medicine, they are the right person to give you the first supply. They know why they chose it, the dose and what to watch for. Your practice may take over repeat prescriptions later, once it has the details and has agreed to.
The hospital told me to get bloods done at the GP
Whoever orders a test is responsible for checking the result and telling you what it means. If we take your blood for a hospital test, the result can fall into a gap between two teams. Ask the hospital where to have it done. Many have their own blood test service.
Can you chase my hospital appointment?
We would like to, but we can't speed up a hospital waiting list. The hospital booking team or department can tell you where you are. If your symptoms are getting worse while you wait, do contact us. That's a clinical change, and we can act on it.
Why did 111 send me to you?
NHS 111 sometimes tells you to contact your GP within a set time. That outcome also comes to the practice, and a clinician reviews it on top of the booked list. But 111 can't see our appointment book. On a busy day there may be no appointment left that fits the timeframe 111 gave you. If so, we may direct you to another service, such as an urgent treatment centre, a pharmacy, or back to 111. That isn't us turning you away. We're making sure you're seen within the time 111 said, by whoever has capacity.
Most of these principles are already in national guidance, in NHS England's The interface between primary and secondary care: key messages for NHS clinicians and managers (BMA summary). This is where the friction shows up in practice:
| What lands in primary care | Why it's sent back | What helps |
|---|---|---|
| Clinic letter: “GP to start [new medicine]” for a patient seen in clinic that day | The initiating clinician holds the decision and should supply the first prescription. We don't ask secondary care to start our antibiotics. | Prescribe from clinic or hospital pharmacy. Hand over repeats with dose, duration, monitoring and stop criteria. |
| “GP to arrange bloods / chase results” | The clinician who requests a test owns the result. Results passed between teams are a known patient safety risk. | Request and follow up your own tests, and tell the patient the result directly. |
| “GP to review” with no clear question | Creates an appointment with no defined outcome, taken from someone else's access. | State the specific action and the timeframe, or keep the follow-up in your own service. |
| Discharge without enough medication | The patient runs short and needs an avoidable urgent appointment before the summary has been actioned. | National guidance: at least 7 days' supply on discharge, unless a shorter course is clinically appropriate. |
| Fit note “from the GP” after admission or surgery | The treating team knows the expected recovery period. | Issue the fit note on discharge, covering the expected recovery period. |
| Shared care started without agreement | Shared care needs the receiving GP to accept clinical responsibility first. | Agree shared care before transfer, and keep prescribing until it is accepted. |
The same applies in the other direction. When primary care refers, we owe you a clear question, the relevant history, and an honest conversation with the patient about what the referral is for.
Who's in the building
“I want to see a doctor” often means “I want to see the right person”. Many practices now have a whole team, and the right person can be quicker and more specialised for your problem. Who is available varies by practice.
GPs
Doctors who manage undifferentiated and complex problems and hold overall clinical oversight.
Advanced practitioners
Experienced clinicians, such as advanced paramedic and nurse practitioners, who assess, diagnose, prescribe and manage same-day and urgent problems.
Practice nurses
Long-term condition reviews, immunisations, cervical screening, wound care and more.
Healthcare assistants
Blood tests, blood pressure, ECGs and health checks, often the step that makes a later appointment useful.
Clinical pharmacists
Medication reviews, reviews after hospital discharge, and complex prescribing questions.
First contact physiotherapists
Muscle, joint and back problems. In many practices you can book directly, without seeing a GP first.
Mental health practitioners
Assessment and support for mental health problems, with links to specialist services.
Dietitians
Specialist advice on nutrition linked to medical conditions.
Social prescribers
Help with what medicine can't fix, such as isolation, money worries and housing, by connecting people with community support.
How well do you know general practice?
Nine questions, some for patients and some for colleagues. Each answer comes with an explanation.
How you can help us help you
None of this is about rationing care. These are the things that would let us give more people proper time.
Please do
- Bring one problem per 10-minute appointment.If you have more, ask reception for a double or triple appointment when you book.
- Tell us at booking if you need an interpreter.We can arrange one, along with a longer appointment, so nothing gets lost in translation.
- Take the appointment you're offered.If reception suggests the physio for a joint problem or the pharmacist for a medicines question, that's the right person, not a second-best.
- Ask the hospital first about hospital care.Questions about hospital medicines, tests and appointments are best answered by the team looking after you there.
- Cancel if you can't come.Someone else can use the slot.
Worth knowing
- An empty waiting room doesn't mean nothing is happening.Most of the day's work is results, letters and prescriptions you never see.
- Reception staff ask questions for a reason.They're making sure you reach the right person, not deciding whether you deserve care.
- Running late is often someone else's emergency.One day it might be yours.
- Sending hospital work back protects your appointments.Every task we take on for another service is time taken from patients waiting to see us.
If you are seriously unwell, don't wait for a GP appointment. Call 999 in an emergency, or use NHS 111 for urgent advice.