BMA suggests workload limits for GPs and unveils 'black alert' system

A safe workload limit for GPs could be as low as 25 routine consultations per day or 10 more complex ones, according to BMA guidance that sets out plans to manage pressure in general practice.

GPs risk slipping into unsafe practice when they deliver more than 35 routine consultations per day, or more than 15 involving long-term conditions, other complex issues or mental health conditions, the BMA guidance warns.

The guidance sets out how a general practice version of the 'black alert' system - which hospitals use to warn that they are facing extreme pressure - could work. The model set out by the BMA could allow practices across a locality to take steps such as shutting down long-term conditions clinics and temporarily suspending planned early hospital discharges.

Unless GPs can collectively agree safe working limits that can then be enforced, the profession's long-term survival is threatened, according to the Workload Control in General Practice guidance.

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'The leaders of general practice must convince their colleagues that to change to safe working practices is not an admission of failure but is instead a crucial step in securing the long-term survival of partnership-based general practice,' the BMA document warns.

Soaring workload in general practice - alongside long-term underfunding - is a key factor driving GPs out of partnership roles and into locum work, the BMA says. The report cites evidence that GP consultation rates rose 15% between 2010/11 and 2014/15.

GPonline reported earlier this year that while GP numbers fell by around 1,300 from September 2015 to September 2017, the number of patients registered with GP practices rose by 1.4m over roughly the same period.

More than a quarter of GPs say they have carried out more than 50 consultations in a day within the past year - twice the limit considered safe by the BMA.

GP pressure

GPC chair Dr Richard Vautrey said: 'Workload pressure is a major issue in general practice with this paper acknowledging the need for a workload control strategy to promote greater quality and redefine the definition of safe working in an increasingly difficult environment.

'GP workloads have become increasingly unmanageable owing to the demand of more complex patient needs, widespread recruitment and retention issues, and years of underinvestment – all of which takes a toll on GPs’ physical, mental and social health.

'With public satisfaction in general practice dropping to its lowest level in 35 years, making improvements to workload is vital to ensure that we can deliver safe high quality patient care, particularly in the management of patients with multiple long-term conditions where there is often a need for less rushed appointments and greater continuity of care.

'Given the clear crisis in general practice, there is an urgent need for cultural shift. Having a system of overworked and undervalued GPs is unsustainable and a change to safe working practices is vital to ensure the survival of general practice.'

The BMA guidance says: 'Appropriate limits on workload will depend on the unique circumstances of each practice and the preferences of each individual GP, as well as the complexity of care being provided. There will also be variation in the amount of spinoff work depending on the complexity of the case mix and also on the contractual status of the doctor.'

Further research by the GPC will aim to produce guidance on how telephone consultations or triage calls equate to face-to-face consultations to 'enable practices to tailor safe practice to their own needs and skills'.

Measures such as a 'rural practice allowance' could be required to help remote practices fund safe working in areas where reliance on support across a locality area is not practical, the BMA warns.

The BMA has promised to carry out further work to define safe working limits, deliver advice for practices on how to implement safe working, and to endorse a locality working model with practices working around an 'overflow hub' that supports practices across each area.

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