Four in five GPs want a cap on face-to-face consultations

Four out of five GPs say the number of face-to-face consultations they can provide per day should be capped, with most supporting a limit of 30 or fewer, a GPonline survey reveals.

Consulting room (Photo: Robert Johns/UNP)
Consulting room (Photo: Robert Johns/UNP)

Many GPs responding to the poll said workload had reached an intolerable level in general practice, with a dwindling workforce struggling to cope with rising numbers of complex, older patients.

With the BMA's GP committee set to publish guidance on workload imminently, the poll of 628 GPs found that 81% would support a cap on face-to-face consultations.

A total of 67% of all respondents backed a cap of between 25 and 40 consultations per day, with a cap of 30 by far the most popular choice. Of GPs who support a cap, two thirds say it should be set at 30 consultations or fewer per day.

Many GPs frequently deliver well above the 30 consultations per day benchmark, the poll found. One in six GPs said they deliver 20-30 consultations per four-hour session on average - meaning 40-60 per full day.

A total of 21% of partners, 18% of salaried GPs and 7% of locums said they carried out 20-30 consultations per average session.

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The poll findings suggest that partners are shouldering a significant share of the workload pressure on general practice, with partners roughly twice as likely as salaried GPs or locums to have completed more than 50 consultations in a day within the last year, and three times as likely to have completed more than 60 in a day. A third of partners had completed more than 50 consultations in a day in the past year, and nearly one in five had completed more than 60.

Figures published last year by NHS Digital revealed the toll this pressure has taken on senior GPs - numbers of GPs in partnership roles are in freefall, with around 2,000 fewer today than two years ago.

Data published exclusively last week by GPonline from the first full year of the GP Health Service - which offers help to GPs facing issues such as burnout, depression, stress or addiction - also make clear the impact on individual GPs of relentless heavy workload, with 1,109 GPs seeking help in the 12 months to 30 January.

Responding to the poll findings, GPC chair Dr Richard Vautrey told GPonline: 'Managing workload to safe levels is more complex that 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.

Longer consultations

'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.

'Salaried GPs should be on a defined contract describing appointment numbers whereas this is not the case for partners who have to respond to the daily demands of their practice population. These are some of the issues our workload group are looking at.

'Some practices have already moved to longer consultations, to both try to improve the quality of the care provided and make the workload more sustainable but accepting that this will reduce the number offered and may lead to patients waiting longer to be seen. Until we see an expansion of the workforce and increased recurrent funding to support this, practices and patients will continue to face this dilemma.'

One GP responding to the poll said: 'I do think there should be a cap. I have transitioned from being a GP partner in an inner-city practice where I used to have up to 60 patient contacts a day to being a deputy medical director of an organisation that delivers care in a different way.

'We don't see more than 30-40 patients in a day and can practice in a much safer way with more integrity. We have excellent retention of GPs and work with a diverse skills mix.'

But one GP opposed to the move said: 'I don't see how a cap would help - we are a profession and can't tell sick patients: "Sorry, I've seen my quota for today". Skill mixing and taking the admin away from clinicians as well as increasing the workforce seem like the answers to me.'

GPonline reported last year that GPs across England are delivering 1m appointments over a limit considered safe by the BMA.

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