Doctors' workload is out of control and must be capped, BMA chair warns MPs

Doctors' workload should be capped to protect them and their patients, the BMA chair has told MPs - warning that the average GP now sees twice as many patients as they should per day.

BMA chair Dr Chaand Nagpaul (Photo: JH Lancy)
BMA chair Dr Chaand Nagpaul (Photo: JH Lancy)

Giving evidence to a House of Commons health and social care select committee meeting on 'workforce burnout and resilience in the NHS and social care', Dr Chaand Nagpaul called for a 'specification of workload limits' to reduce pressure on GPs and other doctors.

He told MPs that GPs now deliver 50-60 patient contacts per day on average - twice the level seen across Europe - and sometimes as many as 100.

The BMA chair said working patterns adopted during the pandemic had increased workload and driven up the number of clinicians experiencing fatigue.

GP workload

Analysis from LMCs recently showed that the pandemic has added 50 hours a week to overall GP workload per average practice, while four in five GPs believe the rise in workload is ‘unsafe for patient care’. BMA figures also show that the number of GPs experiencing work-related mental health problems has risen sharply.

Dr Nagpaul said the pandemic had made unsustainable pressure on GPs worse, arguing that action must be taken to protect doctors' wellbeing in the face of rising workload and intensity of work. He said: ‘Recent studies have shown that [GPs are seeing] 20% more contacts during the pandemic; that could be 30 contacts in the morning and 30 contacts in the evening, but it varies from doctor to doctor.

‘We know that in Europe doctors see between 25-30 patients a day. In the UK, it varies from practice to practice, but in some instances there are as many as 100 contacts a day per GP. Whatever way you look at it, it is significantly more than the contacts we see in Europe. So in the UK we are seeing double what we should be seeing.

‘We certainly think there should be a specification of workload limits. I think it’s the best thing for patients because GPs will be more alert, and they will have more time for them.’

Consultation cap

At a previous evidence hearing, King's Fund senior fellow Professor Michael West warned against a national cap on consultations until more evidence was collected to show the effects. He instead suggested that solutions should be tailored to local pressures.

Dr Nagpaul said greater remote working was adding to pressures felt by clinicians. Describing feedback collected by the BMA from doctors, he said: ‘The one thing they all said is that consultations are getting longer. It’s actually much more difficult to do a video or telephone consultation, I would much rather see patients face-to-face - it’s quicker.

‘GPs also say that they are working longer hours, so they are going in earlier and coming back later, and they are reporting much more fatigue. So the current ways of working during the pandemic have significantly added to the volume of work, contacts and fatigue.’

Around 75% of all consultations were delivered remotely during the first peak of the pandemic. But this number has dropped to around 40% in recent months, with practices offering more face-to-face consultations.

Dr Nagpaul warned that many doctors are reducing their working hours because of the rising intensity of workload and pressure they are under. Retention was 'critical' alongside recruitment of new GPs, he warned - calling for a greater focus on tackling that pressure to help the NHS retain experienced doctors.

Medical director of the NHS Practitioner Health Programme (PHP) Dame Clare Gerada recenlty warned that GP burnout presents is the ‘greatest barrier’ to increased adoption of remote and digital general practice services in future.

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