Mounting workload pressures forcing GPs to 'saturation point', study warns

GP workloads rose by over 16% between 2007 and 2014, according to an analysis of over 101m consultations - forcing GPs to squeeze almost a day's worth of additional work into each week.

The number of consultations rose 6% between 2007 and 2014 (Photo: iStock)
The number of consultations rose 6% between 2007 and 2014 (Photo: iStock)

A team of researchers from the University of Oxford have quantified the extent of the GP workload crisis, warning that the profession is 'approaching saturation point'.

Published in the Lancet, the study suggests that clinical workloads for GPs and practice nurses have increased by 16% over the past seven years as a result of more frequent and longer consultations.

Over a five-day working week, this amounts to GPs fitting in almost an entire day’s worth (80%) of additional work every week in 2014 compared to 2007.

The results follow years of warnings from GP leaders that general practice is on the verge of collapsing from a combination of workload pressures, sustained disinvestment and tumbling workforce numbers.

The study suggests face-to-face GP consultations rose by 6% from 2007 to 2014, hitting an average of 3.18 per person per year.

Meanwhile, average length of a consultation climbed 5% from 8.45 to 8.86 minutes – which researchers warn is piling greater strain on GPs to fulfil other duties between seeing patients.

GP crisis

Time spent on telephone consultations almost doubled from 0.27 to 0.45 per person per year over the same timeframe.

With calls lasting 60% of the time of a face-to-face consultation and a third going on to require follow-up consultations, the authors suggest this shows they are no longer helping GPs cope with demand as originally intended.

The study, a retroactive analysis of over 100m GP and practice nurse consultations, pulled data from almost 400 practices.

It was extracted from the Clinical Practice Research Datalink, where practices record details on all face-to-face consultations, telephone consultations and home visits.

The researchers warned the result is likely to be an underestimate, as consultations and patient contact only make up 60% of GP work time, and the study did not incorporate work such as referrals, teaching, auditing or professional development – which have also risen in recent years.

Although the GP workforce rose by almost 6% over the study period, the authors said this actually equated to a 1% decrease in the number of GPs per patient when accounting for population growth.

The increase in population was fuelled by a disproportionate rise in the number of elderly people and children under five, who tend to rely more heavily on GP services, further impacting workload.

Workload burden

GPC deputy chairman Dr Richard Vautrey said: ‘This study provides clear evidence which supports what every GP and patient knows: GP practices are working harder than ever before, but are struggling to provide even basic levels of care as they are overwhelmed by unsustainable workload.

‘The government has to reverse a disastrous approach that has seen the proportion of NHS funding devoted to general practice dropping from 10.5% to 7.5%. This is starving GP practices of resources and exacerbating shortages in appointments. We need an urgent, sustained package of support for general practice that prevents GP services collapsing completely.’

Dr Maureen Baker, RCGP chairwoman, said: ‘This report should ring alarm bells for the government and spur ministers into action to address the crisis in general practice before it’s too late.

‘For too long GPs have been expected to do more and more for less and less and this perfect storm of rising demand, plummeting resources, and not enough GPs can no longer be ignored.

‘The government must take note of the college’s calls for general practice to receive 11% of the overall NHS budget and urgently implement all aspects of the 10-point-plan to build the GP workforce that we launched last year with NHS England, Health Education England and the BMA.’

Lead author Professor Richard Hobbs said: ‘The demands on general practice have increased substantially over the past seven years. Recruitment of new GPs and nurses remains low while the population in England steadily increases. As currently delivered, the system seems to be approaching saturation point.

‘There are few short term solutions, but reducing the time doctors need to spend on non-clinical duties may help ease the workload temporarily. More research is urgently needed to fully estimate the knock-on effects of increased workloads in general practice on other sectors of the health system.’

A DH spokeswoman said: 'With an ageing population, GPs are seeing more patients with complex health conditions than ever before. That is why we are investing in safer seven-day services and boosting the primary care workforce.

'The new GP contract agreed with the BMA will include an extra £220m, on top of NHS England's commitment to increase investment in general practice by 4.5% every year. Thousands of GPs are also offering video and telephone consultations, helping them attend to patients more quickly.'

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