GP patient contacts running 84% above safe limit, poll suggests

GPs are delivering 84% more patient contacts per day on average than the level considered safe by the BMA, GPonline polling suggests.

Open door to GP surgery consulting room
GP consultations over safe limit (Photo: Robert Johns/UNP)

GPs responding to the GPonline poll reported completing 46 patient contacts on average per full working day over the past year - 84% more than the 25 daily contacts the BMA says could be considered a safe limit.

The BMA safe limit is based on 'routine' consultations - and warns that for consultations involving 'long-term, complex or mental health conditions' anything more than 15 per day could be unsafe. GPs responding to the poll mentioned concerns that patient appointments were ‘more complex’ now than before the pandemic, with people regularly presenting with multiple issues and requiring extended appointments.

GPs delivered on average 16.6 consultations face-to-face and 29.9 by telephone each day, the poll found - with around three fifths of respondents also reporting that they completed online consultations. Those who carried out online consultations completed around 11 on average per day.

GP workload

Seven in 10 of the 287 GPs who took part said daily patient contacts had increased over the past year - with more than a quarter reporting they were ‘significantly higher’. GPs also reported struggling to keep up with administrative work and other contractual duties.

Responding to the findings, BMA GP committee England chair Dr Farah Jameel said current levels of pressure on general practice were 'neither sustainable nor safe'. She warned that general practice was 'buckling and safety is being compromised'.

The findings come after an MDU survey revealed earlier this month that a quarter of GPs were regularly sleep deprived to a level that risked undermining patient care.

One doctor told GPonline they were struggling to fit all of their contractual duties into the day due to increased demand. They said: ‘It's awful - unbearable. There's too much to do to get it all done safely and if you try to be efficient patients complain. I'm shattered and there is no stopping the demand. Patients are aggressive and that is especially wearing.

Long hours

‘I'm consistently working an extra one to three hours unpaid every day - I’m probably doing more than this at times. It makes me want to leave and take up locum work again, plus I'd be able to insist on triage first rather than have patients choose face-to-face without triage which has never been safe with inadequate PPE and the ongoing pandemic.'

Another said: ‘The demand is very high and we have increased patient contact. The only way we can deal with this is for them to be telephone, then the ones you do bring in take 30 minutes per patient as they have so many problems that they want you to address.

‘If we went back to our normal working day it would be impossible. Patients are not happy seeing a paramedic or pharmacist, they say if they had 10 minutes with me I would have sorted it. I explain to them that I don't have 10 minutes to give everyone, otherwise I would never go home because there are not enough GPs.’

Admin work

Practices in parts of England delivered up to 33% more appointments in the three months from September to November 2021 compared with the same period in 2019, GPonline analysis shows. They also conducted millions of vaccine appointments in this time.

Doctors responding to the survey also spoke about the ‘hidden tasks’ that take up just as much time as consultations. One said: ‘Struggling to get admin time and we can no longer do home visits. Telephone consultations are significantly longer than the five to 10 minutes allocated for each one.’

They added: ‘Face-to-face appointments take longer as patients want to "chat"; as the waiting room isn’t as full they assume we're less busy. But they don’t appreciate the number of telephone calls, admin, results, letters, prescription queries and other tasks we do in addition.’

Dr Jameel said: 'To say that GPs are working hard and are stretched to the limit, would be a glorious under-representation of the situation up and down the country.

Record demand

'At a time of national emergency, what any GP will tell you right now – is that they put their patients and their communities first. These findings are reflected in the most recent national GP appointments data publication, which showed that GP practices in England booked a record-breaking 34.6m appointments in November - 1m appointments per day.

'We know that this is neither sustainable nor safe. Not for doctors, and not for patients. Every day, surgeries are doing all they can to meet the needs of an ageing population living with increasingly complex needs, managing the knock-on impact of a record backlog in secondary care, keeping on top of constantly evolving clinical guidelines, all while contending with unrealistic policy expectations of what can be achieved in a consultation or even within ‘scheduled’ opening hours.

'The service is buckling and safety is being compromised. And as we lose more GPs from the workforce, the problem only gets worse, as those remaining are forced to stretch themselves thinner by the day, taking on more.'

Dr Jameel said that with the growing backlog of NHS care and the 'increasing burden of illness', some patients were reporting poor experiences of care despite practice staff going to 'enormous efforts...to accommodate and do more with less and less'.

She added: 'To manage this better, we urgently need policymakers to prioritise and refocus on the one thing that matters right now, delivering timely care for those who need it. We need resources that allow the emphasis to be put on direct patient facing care, and not on targets, allowing GPs and their teams to look after patients who need them most in a way that offers quality and safety.'

Workload pressure in general practice has been compounded in recent weeks by staff absences driven by high levels of COVID-19 infection, with one in five GPs forced to self-isolate in the two weeks after Christmas.

In response to a written question in parliament this week, health minister Maria Caulfield said government plans published in October 'included an additional investment of £250m in a Winter Access Fund to increase the number of face-to-face appointments, while also investing in technology to make it easier for patients to see or speak to their GP'.

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