Give GPs back the freedom to do their jobs, says RCGP chair-elect

GPs are seeing twice as many patients a day compared with 30 years ago and consultations are often significantly more complex, the RCGP chair-elect has warned.

Professor Martin Marshall (Photo: Pete Hill)
Professor Martin Marshall (Photo: Pete Hill)

Professor Martin Marshall said reducing the number of consultations GPs carry out per day and allowing them to spend longer with patients was key to improving job satisfaction and retention, could improve patient outcomes and allow family doctors the freedom to do their jobs.

Professor Marshall, who will take over from Professor Helen Stokes-Lampard as RCGP chair in November, said there was ‘no doubt’ the role of a modern-day GP was much busier now than in the past.

Speaking to GPonline, Professor Marshall said: ‘When I first went into general practice I was probably seeing a maximum of 25 patients a day. I now might see between 50 and 60 patients, plus hundreds of blood tests, plus hundreds of prescriptions.

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‘But the number of patients doesn’t tell you about the complexity of what we are dealing with and, for many doctors, within 10-minute consultations. The kind of conversations we have with our patients are very similar to the types of conversations that we would have had 100 years ago. [But], the complexity of what goes on in those consultations is much greater than it was.

‘There is also a much greater emphasis on sharing information and sharing decisions and all of that requires time.’

A recent RCGP report cited evidence that clinical workload increased by ‘at least 16% between 2007 and 2014’ while numbers of full-time equivalent (FTE) GPs per 1,000 people fell by 5% between 1996 and 2016, with the college warning GPs were ‘currently under huge strain’.

Prevalence of long-term conditions is rising - half of GP appointments are now for patients with at least one chronic condition. As a result, GPs deal with two and a half different issues on average per patient visit, in what the college has called 'some of the shortest GP consultations amongst economically-advanced nations’.

GPs under pressure

Taking pressure off the workforce was identified by Professor Marshall as ‘the single most important issue’ to solving many of the problems faced by general practice, including burnout and retention difficulties.

Figures published last week showed England’s NHS lost 576 full-time equivalent, fully-qualified GPs over the past 12 months.

Meanwhile, the number of GP partners is also declining, with the profession seeing a drop of more than 1,000 FTE partners in the year to June 2019 alone.

Professor Marshall insisted fewer consultations per day would help to reduce the current strain felt by clinicians, while giving them more freedom to do their jobs.

Future of general practice

‘Our expectation is that GPs will have fewer consultations, that has to be the future.This is so that every time a GP sees a patient, they feel that they have done a good job [and] they don’t feel frustrated or that they have been restricted by resource issues that many of us feel at the moment,’ he said.

Professor Marshall added the college remained committed to securing longer consultations to improve patient outcomes.

In May, Professor Stokes-Lampard said it was 'abundantly clear’ that the standard 10-minute appointment was unfit for purpose. The RCGP instead recommended that appointments of at least 15 minutes were made the norm by 2030.

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