MPs explore GP workload cap and flag damaging impact of intense pressure

MPs have raised the prospect of a cap on GP consultations in an investigation into workload intensity and burnout in the NHS - and heard evidence that the health service is 'paradoxically' damaging the health of people working within it.

Portcullis House (Photo: Universal History Archive/Getty Images)
Portcullis House (Photo: Universal History Archive/Getty Images)

‘Chronic stress’ caused by high workload is damaging the health and wellbeing of NHS workers, a senior fellow from the King's Fund think tank told MPs on the House of Commons health and social care committee.

Professor Michael West warned of ‘really disturbing’ physical effects, including increased risk of early mortality for NHS workers. However, he told MPs that primary care staff in some areas had devised effective strategies to tackle rising pressure.

Asked whether staff could be protected by a cap on consultations he argued that more evidence was needed, but suggested that solutions should be tailored to local factors rather than imposed at a national level.

The evidence session came as NHS England announced a £15m plan to strengthen mental health support for nurses, paramedics, therapists, pharmacists, and support staff.

Chronic stress

Frontline GPs have been warning for some time that workload has outstripped pre-pandemic levels as they continue to respond to the COVID-19 crisis, run an expanded flu campaign and deliver an increasing number of face-to-face consultations.

A recent GPonline opinion poll revealed that four in five GPs say their practice is currently facing levels of workload that are above normal, while BMA figures show that the number of GPs experiencing work-related mental health problems has risen sharply.

Professor West warned that chronic stress posed a major problem for healthcare teams. ‘What we've seen, particularly in general practice is that there's much greater complexity of presenting problems and that's increased the workload… and all of those demands have an effect on an individual's ability to respond effectively,' he said.

‘The evidence we have suggests that stress in healthcare does tend to be chronic. If you measure stress at one point of time and again six months later, it's usually at a similar level.'

Impact on NHS staff

He continued: ‘What's really disturbing about this is that we know that this level of chronic stress predicts cardiovascular disorders and disease, addictions, diabetes, cancer, depression. We know that there's a significantly increased likelihood of diagnosis of illness when you have high levels of work demands and greater odds of early mortality.

‘So the paradox is that, in a system focused on promoting health wellbeing, we're damaging the health and wellbeing of a large proportion of our population who work in health and care services.’

Professor West gave examples of how primary care services had tackled intense workload pressures during the pandemic. He recalled how a practice in Cornwall brought in physiotherapists and psychiatric nurses to give GPs more time to work with complex cases.

‘Where teams come together and review what it is they are trying to achieve, what they are faced with, and how they are going about it, and through that review process are coming up with ideas for new and improved ways of delivering services… so there’s something about allowing teams to take time out to review and reflect on how they respond to challenges.’

Consultations cap

Conservative MP and GP Dr Luke Evans asked Professor West if a cap on the number of consultations carried out by clinicians could help to alleviate pressure.

The King's fund senior fellow said: ‘I think that what we need to do is, rather than reaching for one lever and seek a solution like saying it’s the number of patients, much more to gather the evidence - and there's a lot of evidence around about how we can safely deliver high quality care internationally - and adapt that to the local circumstances of the organisations that are delivering care.

'Simply imposing a template on local organisations without taking account of local context often I think creates more problems than it solves.'

NHS England’s national mental health director Claire Murdoch announced in the session that more NHS staff would get rapid access to expanded mental health services as part of efforts to deal with the second wave of coronavirus. The funding package will be spent on creating a national support service for critical care staff, funding nationwide outreach and assessment services, and providing staff with rapid access to mental health services.

The BMA has previously backed a cap on GP workload to protect doctors. Polling by GPonline has shown that four in five GPs would support a cap on face-to-face consultations, with most supporting a limit of 30 or fewer per day.

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