Call for crackdown on unsafe workloads after GP suicides

Doctors' leaders and health regulators have called for an immediate crackdown on ‘unsafe’ workloads following the death of two GPs by suicide in the last nine months.

GP workload warning (Photo: sturti/Getty Images)
GP workload warning (Photo: sturti/Getty Images)

Earlier this week, GPonline reported that 45-year-old Essex GP Dr Paolo Doria took his own life after struggling with depression and ‘an incredibly pressurised’ working environment.

Meanwhile, an inquiry into the death of 43-year-old north London GP Dr Miles Christie, who died by suicide last April, found that he had struggled with a heavy workload and felt unable to talk about his mental health.

Senior GPs have now called for action to help tackle ‘undoable’ workloads in general practice, including a greater focus on expanding the GP workforce to reduce pressure - and warned that the government must come good on its promise to recruit 6,000 more GPs by 2024/25 as ‘a matter of urgency’.

GP workload

The RCGP, BMA and GMC have all called for urgent action to address soaring workload in general practice, with the regulator warning of the 'inevitable impact' on individual GPs. Former RCGP chair Dr Clare Gerada this week told GPonline she believed the time had come to protect doctors by capping the number of patients GPs can see.

Pressure on GP practices is continuing to rise, with 312m appointments delivered in 2019 - up 3.8m from the previous year. This increase has come while the fully-qualified GP workforce remains in decline.

Last October, GPonline reported a sharp rise in GPs seeking help from an NHS service set up to support doctors facing stress and burnout - while a GMC report last November found GPs were working under intense and unsustainable pressure that has eroded standards of care and their relationships with patients.

RCGP chair Professor Martin Marshall warned that without a boost to GP numbers, the profession was fighting a ‘losing battle’ and would remain ‘unsustainable’.

Patient safety

He told GPonline: ‘We want to be able to deliver the best care we can to our patients, but there comes a point when this simply isn’t safe for patients, or for our own health and wellbeing. Some GPs are reporting making upwards of 60 patient contacts a day – each of which involves making a clinical decision - and this is not acceptable.

‘Great strides are being made to increase recruitment to general practice, but when more GPs are leaving than are entering the profession, we are fighting a losing battle.

‘Unless workload is tackled swiftly general practice - the backbone of the NHS - will remain unsustainable. We need to see detailed plans as to how the government aims to deliver its commitment of 6,000 more GPs by 2024/25, as a matter of urgency.’

Reacting to the death of Dr Doria this week, former RCGP chair Dr Gerada - who leads the NHS Practitioner Health programme - said: 'I think the GMC, CQC and NHS England should cap the maximum number of appointments, whilst maintaining [GPs'] pay.

Mindfulness

'They have to to reduce the amount of face-to-face contact GPs have in a week. No amount of mindfulness is going to help a GP who is seeing 60 patients a day.'

BMA representatives backed a cap on workload at the association's annual conference in 2018, but GP committee chair Dr Richard Vautrey warned a cap was difficult to implement.

‘Capping the number of consultations has been suggested before, but it’s difficult to apply the same rule to every practice, where the pattern of appointments, including the increased use of telephone or digital appointments, patient needs, and staff availability, can vary and universal changes can be impractical,' he said.

‘We must address the issues behind unsafe working, which means increasing GP numbers, other clinical staff numbers, ensuring GP workload is manageable, and providing health and care services with the staff and resources required so that patients can access the care they need, when they need it.’

The BMA has previously suggested that an optimal number of consultations per GP is 25 per day, with appointments extended to 15 minutes to give patients and doctors the time they need to discuss the patient’s needs.

A GMC spokesperson agreed that rising workloads were having an ‘inevitable impact’ on GPs. Its recent State of medical education and practice report found more doctors were choosing to reduce their hours to manage their wellbeing.

Although the GMC said it had ‘no role in setting workloads for GPs’, it said it was continuing to work on improving GP welfare and recommitted to taking forward recommendations from its independent review of doctors’ mental health and wellbeing.

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