Most GPs worked beyond safe limit in 2018, poll reveals

Most GPs have worked beyond the level considered safe by the BMA during the past year, a GPonline survey reveals.

GPs under pressure (Photo: iStock.com/SolStock)
GPs under pressure (Photo: iStock.com/SolStock)

More than four in five GPs (83%) responding to the poll said they had carried out more than 30 consultations in a single working day during the past year - higher than the limit suggested last year in BMA advice on safe working.

BMA guidance says that 'up to 25 routine doctor-patient contacts a day could be deemed safe', with GPs at an 'unsafe working level' if they carry out more than 35 routine patient contacts in a day.

More than half of GPs (53%) had carried out more than 40 consultations in a day during the past year, the survey found. One in four had completed more than 50 in a day - twice the BMA-recommended safe limit. Of the 520 GPs who responded, 14% had carried out more than 70 consultations in a day.

The BMA guidance makes clear that for highly complex patient contacts involving long-term conditions or mental health problems, the safe limit for consultations per day falls to 10, with more than 15 considered unsafe. Consultations in this category make up a huge - and increasing - part of GP workload, with research showing that 52% of consultations with patients aged over 18 years old involve multimorbidity.

GPC chair Dr Richard Vautrey told GPonline: 'It's clear from these results that GPs continue to work excessively long hours, which all too often leaves them stressed and exhausted. In such situations the risk is that mistakes will be made, and no patient wants to be looked after by a tired doctor.

'This continued workload pressure is having an impact on recruitment and retention of GPs, and is one of the main reasons we continue to see a fall in GP numbers. We need the recent commitments made in the NHS long-term plan about additional investment into primary and community services to be delivered so that we can expand practice teams to help manage the workload pressures GPs all too often have to contend with.'

Hundreds of GPs responding to the poll spoke of rising pressure and unsustainable workload, and highlighted fears over patient safety and burnout risk for doctors. Many reported considering quitting general practice, stepping back from partnership roles or switching to part-time work.

Unsustainable workload

One respondent wrote: 'GP workload in the NHS is unsustainable. Quite honestly we are being asked to manage more and more risk which is to the detriment of our patients' care as well as our own wellbeing. Burnout is a risk to us all and the profession will suffer as a result if we stay the course.'

Another said: 'The relentless number of consultations has been a significant reason for me to step back, for the sake of my health, and to take early retirement.'

One GP wrote that despite stepping away from a partnership role and taking a salaried post, he was 'in a worse position of still working as much but with much less income' and was now considering leaving the profession.

A handful of GPs left comments suggesing they had been able to manage their workload through a wider use of skill-mix in practice teams, with more nurses and other staff to take pressure off GPs.

GP burnout

GPonline reported in November last year that 1,363 GPs were being treated by the GP Health Service - set up in 2017 to help NHS primary care doctors facing burnout, stress, addiction and other mental health problems.

Meanwhile, numbers of GPs in partnership roles dropped by a staggering 11% between September 2015 and September 2018, official data show.

Neither NHS England nor the DHSC responded to a request for comment. However, the government has promised to increase funding for primary and community care by 4.5bn over the next five years under the NHS long-term plan.

Although the GP workforce remains in decline, record numbers of GP trainees are now in the pipeline. The government hopes to increase GPs' integration with other community primary care services through the rollout of primary care networks across England.

A DHSC spokesperson said: 'As detailed in the NHS long-term plan an extra £4.5bn will be invested in primary medical and community health services by 2023/24. Central to this is expanding the workforce and reducing pressures on general practice by recruiting more GPs, nurses and other health professionals such as pharmacists, physios and paramedics working in bigger teams to provide tailored support to patients, depending on their needs.'

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