Average GP practice working 50 hours a week more in pandemic, LMC report shows

The COVID-19 pandemic has added 50 hours a week to overall GP workload per average practice, according to an LMC report that warns the profession needs more than 7,000 extra GPs to keep up.

GP workload surge (Photo: Robert Johns/UNP)
GP workload surge (Photo: Robert Johns/UNP)

Data from 109 GP practices across Bedfordshire, Hertfordshire and Cambridgeshire found that total GP hours worked have spiked by 56% because of additional work triggered by the pandemic.

Four in five GPs believe the rise in workload is 'unsafe for patient care', nearly nine out of 10 felt under pressure to accept work transferred from hospitals - and 93% said the status quo was damaging morale.

The findings offer one of the first in-depth looks at the extent of extra workload soaked up in primary care during the pandemic as practices switched rapidly to a 'total triage' model to keep patients safe while coping with extra pressure triggered by a reduction in other NHS services.

GP workload

GPonline reported at the start of the second wave of coronavirus that GP practices were delivering more consultations and clinical administration work than a year ago - and GPs have repeatedly warned the profession is working harder than ever.

But the analysis from Bedfordshire and Hertfordshire LMC and Cambridgeshire LMC suggests the impact of the pandemic on practices is far greater than has been shown previously.

A report by the LMCs shows that in September 2020 GP workload per 10,000 patients totalled 9,218 minutes per week - up 56% from the same month in 2019. For an average-sized practice with just over 9,000 patients, this equates to an extra 50 hours a week of GP time.

Practices are completing fewer face-to-face consultations, but these visits are taking nearly twice as long; while telephone consultations, work transferred from hospitals, video consultations and time spent on 'indirect patient care' have rocketed.

GP workforce

The report estimates that 368 extra full-time GPs are needed across three CCGs in Bedfordshire, Cambridgeshire and Peterborough, Hertfordshire and West Essex that cover around 3.5m patients - and that nationally as many as 7,391 full-time GPs are needed 'to sustain the additional levels of workload seen in September 2020'.

Time spent on telephone consultations has quadupled compared with last year, the report shows, while time spent on 'indirect patient care' such as emails, text messages, and communication with patients via tools such as Doctorlink, AccuRx, AskMyGP and eConsult has more than doubled.

Video consultations now account for around 7% of GP time compared with almost none a year ago, and work transferred from hospitals accounts for nearly nine hours per week of time per 10,000-patient practice, the report says.

The average length of a face-to-face consultation has shot up from 11 minutes to 19 minutes, while phone consultations have gone from less than eight to around 11 minutes on average, with a similar change in length for video consultations.

COVID-19 pandemic

The report's executive summary warns: 'COVID-19 necessitated an overnight transformation in the operational delivery model across primary care. This led to a significant workload shift into practices, which exacerbated existing challenges, given the finite resources of practice teams, time and funding.

'Damaging misinformation in parts of the media has impacted upon the morale of an already saturated and exhausted workforce. It is unsustainable and unsafe for GPs to be working excessive hours at the expense of their own health, due to a lack of workload control. The announcement of the COVID-19 vaccination programme has added another layer of challenge.'

Cambridgeshire LMC chief executive Dr Katie Bramall-Stainer told GPonline: 'As we go into November it almost feels like it should be February.'

She said that GPs had been 'slogging away for months', coping with a rapid shift in the way care is delivered, carrying significantly increased clinical risk, working on an expanded flu campaign, prioritising workload around chronic disease management, carrying out catch-up clinics for school and shingles vaccinations, continuing to work on elements of QOF and more.

The report concludes that the 'anticipated escalation in activity that we are already seeing, equates to a sustained clinical risk in which demand outstrips resource' - warning that LMCs will support practices in taking measures to protect themselves such as setting limits on safe working and increased signposting of patients to other services such as pharmacy, 111, urgent or emergency care.

It adds: 'It is beholden upon those at the very highest level seeking to develop a true system approach, to consider the impact of what is currently happening - and try and put in place processes to make reparations to general practice, in order to secure system sustainability and patient flows of care going forwards.'

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