GPs' administrative load revealed

As GP's survey reveals the vast administrative workload facing GPs, Abi Rimmer considers the factors fuelling it.

Dr Richard Fieldhouse: the workforce of general practice needs to change; the partnership model is broken
Dr Richard Fieldhouse: the workforce of general practice needs to change; the partnership model is broken

GP workload is rising while work/life balance deteriorates, a GP survey of more than 1,600 partners, registrars and sessionals has found.

85% of GPs say the amount of administration work they do has increased over the past 12 months. Half of GPs are now thinking of quitting medicine altogether because of workload pressures.

In addition, 40% said they are considering moving abroad to work and one in five said they were thinking of switching to another specialty.

GP's poll suggests that, although the government's NHS reforms have played a part in adding to GPs' workload, other factors have also increased bureaucracy.

45% of locums and salaried GPs say the creation of clinical commissioning groups has added to their workload and 75% of partners were of the same opinion.

But more long-established factors have had a greater impact on GP workload.

78% of GPs say prescribing and medicines management initiatives have increased the amount of administration they have to undertake.

Increased bureaucracy
A similar proportion cite QOF, revalidation or CPD requirements as having increased bureaucracy.

Secretary of Northumberland LMC Dr Jane Lothian says GPs, and partners in particular, are working increasingly long hours. 'Most of my partner constituents say they are working 11 or 12 hour days,' she says.

Among partners responding to our survey, more than 90% say administration has risen over the past year and more than 70% now work more than 48 hours per week.

In addition, while only a third of partners are able to spend more than 60% of their time with patients, nearly 80% of locum and salaried GPs spent at least this amount of time with their patients.

One GP partner from Cardiff attributed the rise in administration to increased red tape and appraisal demands.

'There is an ever increasing paperwork burden - we had to reapply for accreditation for all our local enhanced services for instance,' he said. 'Appraisal gets ever more labyrinthine each year and practice staff management takes ever more time.'

A number of GPs who responded to the survey say that having partners who worked on commissioning has meant their own workload has increased.

A GP from Greater Manchester said: 'My GP partner is on the local commissioning board. He attends meetings regularly during the week, missing at least one session, sometimes more.

'We have a locum but they only cover surgery appointments so all visits, post, results, nurse, social worker and reception enquiries have to be dealt with by me instead of shared.'

But DoH national clinical commissioning network lead Dr James Kingsland says one of the main aims for the government's NHS reforms was reducing bureaucracy.

Dr Kingsland says it is important to look at what has been achieved by commissioning meetings so far.

'How has care changed as a result of these meetings? If nothing has changed then they are just increased bureaucracy,' he says.

Endless workload
A GP from Exmouth, Devon, who is considering quitting medicine all together, said the list of bureaucracy and rising workload seems endless.

Asked for details of examples of rising workload, the GP said: 'QIPP, QOF, medicines management, referral management, patient participation groups, endless retraining certificates for basic functions - cervical smears, family planning devices, minor ops. Commissioning groups, complex care groups, the list is endless or seems to be.'

Dr Kingsland said that he was receiving an increasing number of calls from colleagues wanting to leave general practice, because of the ever-increasing workload.

'I am hearing about too many GPs leaving general practice before retirement age and that is a major worry,' he says.

But not everyone thinks the paperwork facing GPs today is worse than that managed by GPs for decades.

Family Doctor Association chairman Dr Peter Swinyard argues that GPs are better off now than when they had 24-hour responsibilities.

'It was ever thus,' he says. 'It's better now that we don't have out-of-hours duties.'

National Association of Sessional GPs chairman Dr Richard Fieldhouse says that the workforce structure of general practice needs to change.

The current partnership model is 'not fit for purpose' and locums are now carrying out more everyday 'general practice' than partners.

'As a locum you get the nice aspects of patient care, you don't have to go to this meeting or that meeting,' he says.

'That is not why people go to medical school. That is not why people become doctors.'

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