GPs behind closed doors: the inside story

How would you feel if you were asked to ‘bare all’ for the TV cameras? For one practice nurse, revealing the work of the practice nursing team for a long running TV series was quite an eye-opener

Would you like to be filmed at work for eight months?’

This was the proposition put to our surgery in the Spring of 2015 by the producers of GPs: Behind closed doors looking for a base for their third TV series.

Our first inclination was ‘no way’. But following meetings and consultations with the whole staff team we began to be enthusiastic. Some of us had seen the first two series and felt that primary care had been portrayed in a positive way; also some of our GPs knew colleagues at Putneymead where the previous series had been filmed and they reported that it had been a good experience. There had been a lot of negative press about GP surgeries in general and we wanted to show what we think are our excellent services.

We had also just passed our CQC inspection as ‘Good in all areas’ so felt (reasonably) confident about exposing ourselves.

However, previous series had been much shorter and the prospect of having a TV crew with us for eight months was quite daunting. As there would be forty episodes the producers wanted to show more of the practice nurse and HCA roles than had been shown in the first two series.

I felt it was an opportunity to show the public (and our families!) what a wide selection of skills practice nurses have. As well as the usual nurse clinics I do minor surgery, and my colleague Kate fits implants. I have worked at the surgery for 20 years and felt it was an opportunity to shake things up and also change the routine of the year.

Although the thought of taking part in a TV series seemed quite exciting we all had anxieties:

• ’What if we made an error in the information we gave out and all the nurses and GPs in the country criticised us?’
• ’What if we are made to look uncaring or lacking in some skills?’
• ‘Would we have any input during the editing process?’

The deadline for starting filming was short but after negotiations with the production company (Knickerbockerglory) and approval from Channel 5, filming started on 1 June 2015.

The previous week cameras were installed in one nurse’s room (out of four) and five doctors’ rooms (out of eight). The cameras are ‘fixed rig’ (no camera men in the room!). My room had four small cameras: two close to my desk, one over the examination couch, and one on the wall. There were two microphones: one under my desk towards where the patient sits, and one by the couch. All the clinicians who were being filmed and the receptionists wore tiny microphones clipped to their clothing.

Meanwhile, upstairs, our IT manager had been ousted from his office and this became the ‘Gallery’. This housed 32 screens (like a CCTV control centre) and at least eight members of the crew. All the cameras were controlled from here.

Everyone in the surgery had the choice of whether to take part or not, although of course we needed a majority to take part to make filming feasible. In the end two of our four practice nurses, including myself, three of our four Health Care Assistants and the majority of GPs agreed to be filmed. Those who did not want to take part were scheduled to work in rooms without cameras.

What about patient consent? This was the main topic that came up in the negotiations.

This is what happens: a team of four from the production company were in our waiting room all the time that filming took place. Their primary job was to explain to all patients about the filming. When patients arrived they were asked who they were seeing. If they were seeing a ‘non-filmer’ some explanation of what was going on was given but they were told they would not be filmed. If the patient was booked to see a clinician who was being filmed they were asked if they wished to have their consultation filmed and to give formal consent to take part. No pressure was put on the patients at any time. Patients were never filmed if they had not consented. All patients who feature in an episode of the series are also contacted again by the production company to remind them of their consultation and consent for a second time.

The first day of filming was notable for an increase in makeup and care in appearance of the staff who were going to be filmed! This effect did wear off as time went on…

I felt very self conscious to begin with, especially if I saw the camera move, so that I knew a particular consultation was being filmed. We didn’t always know which consultations were being filmed – although some patients told us as they arrived. On the whole I preferred not to know and tried to carry on as normal.

We had decided not to change any of our clinical practice for the benefit of the cameras, as we have confidence in the service we give. For example, our phlebotomists and practice nurses never wear gloves to take blood. We prefer to wash hands and use alcohol gel, and though there are protocols from Public Health England saying this is acceptable, we knew this might get criticised (and it was, via Twitter!). Also our practice nurses don’t wear uniform and this also seems to faze viewers.

On the whole patients were positive and proud that ‘their’ surgery was going to be shown on TV. We had three (out of 19,000) patients make formal complaints to our managing partner that they felt we should not have taken part. These patients were always offered rooms without cameras. Our surgery has a very active patient led liaison group – they had been consulted from the start and were very keen that we should take part.

The series started airing on TV in October 2015. However, before this all of us being filmed had seen ‘fine cuts’ of the programmes in advance. This was our chance to ask for alterations if we felt we had been misrepresented in any way. A consultation of 15 minutes would have been edited down to probably 3 minutes so obviously a lot of what we might have said gets taken out. We had an agreement between ourselves to be honest with each other and feedback if we thought something should be changed or was in anyway inappropriate. Seeing everyone’s consultations stimulated much lively debate, for example about the use of chaperones, as it became clear that some GPs used one and others did not. We all learnt about each other’s practices. For examples, some GPs were unaware that stickers are a magic panacea for 3 and 4 year olds – after seeing the nurses offer them, all the GPs requested rolls of stickers. I was fascinated to see one of our GPs perform the Epley manoeuvre for a patient with vertigo, something I had not seen before.

In fact we didn’t have to ask for many changes. I had one consultation where I was interviewed about doing minor surgery, which I do for minor skin lesions. When I saw the edit I asked for a comment I had made about always referring any suspicious lesions to the hospital, that had been edited out, to be put back in as I felt it gave the impression that I would deal with these. In another consultation about travel I asked for advice about malaria that I had given to be put back in, as I felt it looked as if I hadn’t mentioned it.

When the first programme went out we were all very nervous about seeing ourselves.

Most of us were alarmed about how we looked and sounded, but gradually over the weeks have got used to it. A lot of clothes were sent to charity shops after seeing what they looked like! Of course we were all highly critical of ourselves and our appearances, but very positive about everyone else.

The feedback has been overwhelmingly positive – the many comments on Twitter about what a great surgery we are, or liking particular doctors, were great to read.

The Twitter phenomenon was new to me. It’s very disconcerting to have anonymous people making critical (and sometimes rude) comments. The first time I read a negative comment about myself I was upset, but now I can put it in perspective.

People who tweet are maybe only 20 or so of the 1.3 million people who watch every week.

At the time of writing we are on our last week of filming, although only 16 of 40 shows have aired so far. Overall it has been a very positive experience; we have got to know the crew and will be sad when they go. Those of us taking part have got to know each other much better – it has been like a long bonding experience. We have done many more social events as well. A group of us even did a charity swim with members of the TV crew in the unheated outdoor pool at Tooting Lido on a freezing Saturday in January.

I think those who chose not to take part may have felt a little left out at times, although they have always been invited to social events associated with the filming.

Seeing our colleagues and how good they are has been a very morale boosting experience. We have all also learnt more about each other and picked up good consultation tips.

Lastly to answer some of the questions that are put to us…

• No, nothing is staged. All the patients are real patients and they were not asked to ‘perform’ in any way.
• No, our doctors aren’t ‘putting on’ being so nice – they really are!
• Yes, we do always open the door and greet patients and see them out – it’s our surgery policy, and
• No! Neither the staff nor patients were paid to take part.

If any of you are offered the chance to take part in this sort of project my advice would be ‘go for it’. For our surgery it has been an overwhelmingly positive experience.