STRESSED doctors in Bolton are being balloted for strike action in a passionate uprising against the Government. They want more doctors in the town and less pen pushing bureaucracy to free up their time to spend with patients -- and their own families. The BEN's health reporter, Gayle Evans, takes a look at a typical day at a busy Bolton practice which has more than 8,500 patients on its books... DR Ian James became a GP more than 20 years ago after being attracted to the idea that he would be his own boss running his own "shop".

Today, his attitude has changed. He feels he is overworked and undervalued. Patient waiting lists are growing longer, his pile of paperwork is becoming larger and his own standard of living is falling.

Dr James qualified in 1974 but became a GP at Spring House Surgery, Chorley Old Road, Bolton, in 1981.

The 51-year-old father-of-two, who is responsible for 2,000 patients, said: "The job has changed immensely. There are more constraints. Doctors are being lent on by the General Medical Council and the local health authorities."

The job has its good points, according to Dr James. He said: "It's very rewarding developing relationships with your patients and getting to know them extremely well.

"But I don't spend that much time with my family."

Dr James, who has been involved in training doctors to become GPs, has called for more doctors to reduce patient ratios in Bolton -- giving GPs longer than 15 minutes per patient. He believes he should only have 1,500 people on his record books.

But Dr James says there must be less emphasis on academic prowess in a bid to encourage more men to enter the medical profession.

New doctors in Bolton, and nationwide, tend to be female because more women students are making the grade than men.

Dr James said: "Female doctors tend to want to work part-time due to family reasons which creates a hole. There are also large numbers of ethnic doctors due to retire soon. There will be a severe shortage in Bolton in the next few years."

The doctors "union" the British Medical Association is balloting members to see whether they want to opt out of the NHS in protest against the high workloads and stress. Dr James said: "It is very stressful for doctors today. Just seeing patient after patient is stressful. Many patients need much longer than their allocated eight minutes and many are suffering from some sort of depressive disorder.

"Doctors also get very worked up because of long waiting lists when their patients can't get the treatment they need from the hospital."

Many doctors are being forced to carry out private medical work in order to keep their standard of living.

Dr James is no exception and works for a private medical insurance company to boost his pay packet to maintain his own personal living standards.

He explained: "GPs in the early 1980s received what was comparable to solicitors and the pay was quite reasonable.

"Today, it is probably only about 70 per cent of what we got in the early 80s. Financially, GPs are undervalued."

But Dr James praised his patients who offered him support and understanding for his heavy workload.

He added: "I don't feel undervalued from the point of view of the patients. They are very understanding. But most GPs will say the same things. Short of taking on extra work, which is difficult under the stresses of the NHS, they are going to lose out."

The local doctor has also criticised moves to reorganise Bolton's health, to form Primary Care Trusts, claiming politicians are "going around in circles."

The town's health system will undergo a radical shake-up as more local committees, governed by doctors, take over the reigns on health issues from 2002.

But Dr James, a former fund-holding GP, stormed: "Where will doctors find the time?"

He praised the old system of fund-holding -- abolished under the Labour government -- which he claims allowed doctors better control over the welfare of their parents.

And Dr James slammed government proposals to train up nurse practitioners who are expected to take over patient monitoring.

He said: "At the end of the day, the buck will still stop with doctors." A TYPICAL working day for Dr James: 7.30am: Arrive at work. Carry out paperwork. Look at hospital results and medical reports. Deal with practice audits.

8.30am-9am: Consult with patients over the telephone regarding home visits and medical advice. Dr James said: "Home visits can be very time consuming. We try to deal with as many as we can over the telephone. A growing number of elderly patients makes home visits a large part of our workload. Heavy traffic makes it time consuming."

9am--11.30am: Surgery. Can see up to 20 patients lasting from four minute consultations to 15 minutes. Many suffer chronic depression which require further appointments. Dr James said: "An increasing number of our patients now suffer from depression. This is an increasing role for doctors having to treat more cases. It can be very rewarding. But the improvement in science means doctors have a bigger role to play in monitoring and prescribing better drugs."

11.30am-3.30pm: An opportunity to carry out private medical work (where GPs get extra money to boost their pay). Dr James will grab a sandwich while driving to more home visits.

3.30pm-5pm: More paper work. On quieter days, Dr James may venture home to look in on his family.

5pm-7.30pm: Surgery. Will see an average of 20 patients. Similar to morning surgery.

7.30pm-10pm: More paperwork. Also deal with any on call medical emergencies from his practice (although many Bolton doctors now use a subsidised service, run by GPs for GPs, based at Landmark House).

10pm: Home. WHAT THE PATIENTS SAY: BOLTON patients have come out in support of fed-up GPs, sympathising with their heavy workloads.

Susan Smith, 46, said: "I'm very happy with my doctor. He sits down and actually listens to what I have to say. He understands."

Joan Carter, 64, admitted that sometimes she felt that she needed a little bit longer with her GP to discuss problems. But Mrs Carter added: "They do listen and try their best. I'm not worried about the future. I realise that doctors will not make patients suffer. I support whatever action they want to take."

Joan Harrison, 63, also showed sympathy to a doctor's workload. She said: "We've been with this doctor for 15 months and are very happy. They are particularly good at dealing with what is wrong with you and getting a quick diagnosis.They are very sensitive."

Husband, Brian Harrison, 65, added: "I was sent to a private clinic for treatment because the doctors run a private fund-holding practice. So despite the extra costs to them, they did what was best for me. Doctors these days are being given too much responsibility. Something is going to crack."

Anita Holden, 46, showed no surprise at news that doctors were unhappy. She said: "It's a very difficult job to do -- although it must be easier with prescriptions being printed out by computer."

Mum-of-four Melanie Hardman, 24, had nothing but praise for her GP who was "very accommodating". She added: "He never hesitated to turn up at home to see my children who were ill. But you never really hear about doctors' problems do you? They don't sit down and moan about their workload."