In Conversation with GP Mei Till

BY Almeida Theatre   May 3, 2016

During rehearsals for Boy, company members Peter Temple, Wendy Kweh, Georgie Lord and Caitriona Shoobridge met with GP Mei Till. Below are excerpts from their conversation. 

Mei: Three years ago, I used to come a bit early to the practice, sign a couple of [prescriptions], and then get on with the job. And it’d be fine… Now I come in 7.30, 7.45, we’ve got DocMan – these letters from patients that are scanned in from hospitals or A&E, and you can have up to 120 – and they’re just sitting there, and you’re like… It’s a well-known fact that GPs actually do compensate, we put ‘out of office’ – we aren’t really out of office, but we can’t handle it anymore.

 

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Mei: So what happens is, when the patient books in, it’s a 10-minute appointment each – and actually, now we don’t have catch-up slots. So usually, in the past, it would have been say four patients and then you have a catch-up slot which would have been 10 minutes, so therefore you can play with that time. Say a patient presents with depression or an STI that you need to counsel them, you can stretch that time and then everything else doesn’t run late. But if that patient – if what’s on your mind is that you can’t do that in 10 minutes – then when you get to mid-surgery, you’ve suddenly got all the other patients waiting, and you’re running about an hour late, and it gets even more stressful as you’re going along your surgery, because you can see the patients arriving: it goes A, A, A, A.

Wendy: A, A, A means – ?

Mei: ‘Arrive.’ There’s no catch up slot.
And as you are consulting, you’ve got these pop-up things here that say, “Need to ask patient smoking,” “need to ask blood pressures,” so you need to hit those targets while doing that…

 

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Peter: So who’s popping those up on
you?

Mei: The government. So if a patient’s got angina, they’ll go, “Why is the patient not on aspirin?” So even though this patient’s coming to you with depression, you’ve got to try and meet that target; somehow you’ve got to put it in the consultation.

Caitriona: Am I right in thinking you’ve had a patient-per-head cut? Have you got fewer doctors to deal with all of that than you did before?

Mei: We have. Because all the money is the same, or the money is cut down – so it used to be £93 a patient, and now it’s £75. So actually, all GPs run as a business, so you literally cannot employ more doctors to fill the patients because otherwise there’s no point in running the business. You still have to employ the staff, the receptionists. And also the receptionists get it in the neck – because there’s not enough doctors, we can’t release more appointments, therefore you’ve got the patients going,“Well, when’s the next appointment?” You know, the whole system goes down; the whole system is like a bubble, and it’s ready to pop.

 

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Wendy: And in terms of life after surgery, do you ever manage to have a life and take your own advice and get exercise and eat and…? I mean, I see you’ve got trainers on…

Mei: For me, I do – but there are a lot of doctors that don’t look after themselves. There’s a lot of mental health amongst female doctors particularly. It used to be males, old GPs [dealing with] alcohol, and now it’s the new generation of mid-30s to 40s: anxious, probably clinically depressed, but it manifests as anxiety, so constantly worrying about the patient that they have let go, because you’re dealing with a lot of uncertainty in general practice.

 

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Georgie: Do you have a lot of doctors that just don’t want to be doctors anymore?

Mei: People tend to stick in to the thing... Right at the beginning, before you enter med school, you are picked already for your resilience. My husband does med school interviews for Kings College Hospital, and as part of the OSCE [examinations] they have all these stages they do, and these are testing empathy and resilience, so we’re already selecting that group of people who will just march on and go on, you see what I mean?

 

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Peter: So government takes advantage of the fact that you are resilient, so whatever they manage to throw at you, you will just keep going.

Mei: Yeah.

Peter: And that’s where the resentment comes from.

Mei: Yeah.

Georgie: Do you feel like the cuts in the mental health sector have changed things in the practice?

Mei: Yes. They’re presenting more acutely now. For example, in Haringey, we have something called St Anne’s where if you’re acutely psychotic or acutely depressed, it was a walk-in – you would go and get assessed. That has closed down now, so it falls on us. So we call something called Crisis Team, who are meant to be 24 hours a day, and you’ve got a mental health nurse on the end of the line going, ‘Do you think that patient will kill himself?’ You know, all these kind of questions, and you’re like, ‘Yes, can you just see the patient?’ and they’re like, ‘Do you think you can let the patient go home, and we can see him there?’ And you’re thinking, ‘I don’t know, but actually, I need you to get this patient off me so I can see the next 10 patients, because this patient has taken a half hour of my time.’ That’s the kind of thing you’re thinking of.

Wendy: Such a time pressure is the biggest anxiety-causing thing in this job?

Mei: Yeah.

 

Boy | 5 April - 28 May | Info & Tickets