I remember Charlie, an old GP who worked before the NHS began in 1948, telling me that the total GP team in his practice then consisted of just three people - himself, his wife who answered the phone working as the receptionist and the debt collector who ensured that patients paid for their consultations. He never wanted to go back to what he felt were the bad old days of asking patients to pay for their GP services.

The multidisciplinary team in a GP practice now is an impressive resource providing a breadth of service and expertise that Charlie would be amazed at. GPs are now supported in their work by nurses, social workers, reception staff, pharmacists, mental health workers, physiotherapists and health visitors. The practice also liaises with other community services provided by the local health trust and important services such as Foyle Hospice who provide an outstanding service for our palliative care patients.

This community team works really hard to provide as many services for patients as close to home as possible as people generally don’t want to go to hospital and we aim to limit our referrals to hospital to about 5% of the patients we see.

One of the trials of being a GP is the intrusion of technology in the form of computers and the IT that is necessary to coordinate all of this work. I opened up a screen during the week to book an appointment for a nurse for a patient who was with me. On that day we had a nurse running a diabetic clinic, another nurse running an asthma clinic, a nurse in the treatment room for dressings, ECGs and lab tests, and finally a phlebotomist working alongside the nurses in the treatment room doing blood tests; helping the nurses with the massive demand for tests often requested by the hospital.

A key member of the multidisciplinary team now is the pharmacist who works in most practices as GPs prescribe nearly 50 million prescriptions a year in Northern Ireland with an average practice issuing about 800 prescriptions per day. Many of our older patients with complex medical histories can be on more than 20 different medications per day some of which required monitoring with blood tests for kidney and liver function. The pharmacists bring their expertise to the team to help these patients and keep them safe.

Social workers in GP practices are a recent innovation connecting patients to community services and focusing on isolated patients to help with loneliness, housing and finances.

The mental health workers and physiotherapists have brought further expertise to the primary care team ensuring that patients can access services in the community without sitting on long waiting lists for hospital services. They provide prompt, expert assessment and advice to these patients so that they don’t need to be referred to hospital.

The key people in the service of course are the GP receptionists who manage to coordinate the access to this complex system with many now trained in the role of care navigator.

The multidisciplinary team in a GP practice now is an impressive resource.

We’ve come a long way from my friend Charlie and his debt collector and of course we’re now looking forward to the next evolution of the extended multidisciplinary GP team with the imminent introduction of our AI avatar-strange times indeed.