Former GPC chair Dr Laurence Buckman - who was among the architects of the 2004 new GMS contract - warned this week that ‘the pressure to perform better and longer for more and more patients, with greater degrees of complexity, is now dangerous - for them and us’.
He implored fellow GPs to support the BMA’s recent call to limit the daily number of consultations, adding that ‘tired GPs risk harming patients - and themselves through stress associated illness'. Writing in the BMJ, he warned: 'I am not prepared to die for the NHS.’
The concept of 10-minute GP consultations has long been a concern for GP leaders. RCGP vice chair Professor Martin Marshall described the model as a ‘disaster’ last week, and experts have warned that 10 minutes is insufficient for the 50%-plus of consultations that involve patients with multiple long-term conditions.
Dr Buckman said: ‘My day as a principal is typically 12-14 hours long. I know sadly that I do not think as quickly or as laterally at the end of the evening as at the beginning of the day.
‘Like many GPs we start out with a "fixed number" of appointments - 18 surgery consultations in each half day - but we also have a policy to turn away nobody who says he or she is in need.
‘We cope with this load. What crushes us is the bureaucracy (repeated referrals for the same problem, obstructive referral management systems, form filling, etc) not the (largely understandable) demand from patients. But, by the time I get home the compassion has nearly run dry.’
While genuine emergencies should not be limited, Dr Buckman went on to say that most so-called emergencies are for minor ailments or simple queries and none of these justify working into the evening. He concluded that, despite being reluctant to open GPs up to more attacks about lack of availability, doctors must unite to tackle this issue head on before it is too late.
‘We have to tell those who turn the tap that only so much water will go under the bridge today, for their safety and ours. Politicians must be honest with their voters - we have run out of doctors and time.’
Dr Michael Griffiths, a GP partner, argued in the same discussion piece that such measures would limit GPs' flexibility and professionalism when dealing with patients, saying primary care should instead be granted additional resources ‘to manage work that we could undertake if properly funded’.
He added that a cap would result in ‘the loss of patient access to their GP, loss of professionalism on the part of the GP, and a risk of missing something that is at least as great as continuing to work when fatigued.’
‘What is needed is a greater proportion of NHS resource coming to primary care to enable us to administer our practices properly, allowing the right professional enough time to devote to each patient without feeling exhausted at the end of the day,’ he concluded.
Earlier this year, a poll conducted by GPonline found that the majority of GPs would support a cap on consultations. Addressing the findings at the time, GPC chair Dr Richard Vautrey said: ‘Managing workload to safe levels is more complex than just setting a number of consultations. It also needs to take into account the many other activities GPs do each day, including managing prescriptions, reviewing results and dealing with paperwork.
'All of this adds to the stress and overload felt by many GPs. GPs can struggle with a small number of consultations that are very complex and where patients bring multiple issues that need to be dealt with compared with a larger number that are more straightforward and for single issues.’