I’ve been feeling uncomfortable recently—it’s not something I need to see my GP about, particularly as he probably feels the same way. Several of my relationships are breaking down. At the practice where I have worked for 30 years, we meet over coffee every morning to share the home-visit load. With increasing patient demand, we now visit about 30% more patients than we did last year and offer more GP consultations. Most GPs start earlier and finish later. We ‘hot desk’ and talk to each other less. When we try to contact secondary care, bleeps go unanswered, medical secretaries are answerphones, and emails are returned ‘out of office’.

I expect to work hard but I’m not sure our patients understand what is happening. It’s common for them to be discharged from hospital without a letter listing all the medication I should now be issuing, and the referrals I should make for all those ‘incidentalomas’ picked up on the many radiological investigations they have had.

My policy of treating everyone to the best of my ability, following the CCG care pathways, is unpopular with patients since several of them (usually the hospital clinicians) just want me to drop a line to a colleague so they can have a cosmetic procedure.

What could be improved? The volume of data gathered by Datix about poor patient care, presented by our CCG to secondary care, has produced real improvements. We should use it more.

Patients and doctors also need to face up to the gap between expectations and funding. As a GP, I want to work with everyone to maintain high standards. The piece in the Christmas 2013 BMJ about the time it takes for hospital staff to get to speak to GPs,1 did not help: it would have been only fair also to publish something about the time our local acute hospital takes to answer the phone. I can see the hospital from my consulting room but sometimes it feels like a different planet.

Dr Honor Merriman, GP and CPD Tutor, Oxfordshire

1. Webb J, Ward D. Phoning the patient’s general practitioner. BMJ 2013; 347: f7048