The underlying problem is our independent contractor status: this allows the NHS to increase our workload without being held legally responsible for the consequences. By contrast, were we to be directly employed, NHS managers could be held firmly to account over our health and safety, workload and working conditions. With a preset working week, any extra duties would have to be balanced against reduced demands elsewhere.
What can we do in the short term about stress and burnout? Certainly, each practice could take on more doctors and nurses: indeed, I suspect this is what the DH and the politicians hope we'll do. But even if we could find the extra clinicians - by no means certain in the present climate - such a strategy would backfire. It would hugely diminish practice profitability, seriously reduce the financial attractiveness of general practice to new doctors, and quickly condemn primary care to Cinderella status.
Alternatively, GPs could aim to become direct employees of the NHS, able at last to say 'no' to extra work. It would be NHS managers, not us, who would be held to account if primary care services weren't available. GPs would have set shifts; and when managers wanted us to attend meetings or sent us on unnecessary refresher courses then it would be the NHS, not the GPs, who had to find the locums - and fund them, too.
But the downside would be huge. We'd be micro-managed. As employees we would no longer have a guaranteed life-time contract at one practice; we could be relocated, suspended or made redundant on a managerial whim. The wider NHS would lose out too, because the financial incentives for independent contractors help in making primary care so cost-effective.
Is there a half-way house? Could we retain GP independence, yet hold NHS managers fully to account for their decisions about us? This is the nub of the problem. Sadly, I doubt if it is legally possible, which is why GP burnout is likely to remain with us for many years to come.