GPonline reported this week that two thirds of GPs take no breaks during an average clinical session, with many saying they struggle to take a break at any point during a full working day.
This pressure-cooker environment - fuelled by falling GP numbers, rising numbers of patients registered with GPs and an ageing population increasingly with multiple long-term conditions - saw more than 1,100 GPs seek help for burnout and stress with the specialist GP Health Service in its first year.
The GPC, meanwhile, has begun setting out plans for workload limits, and a potential 'black alert' system for primary care. But while these measures remain in the pipeline, GPs are facing increasingly intolerable pressure - below, GPonline looks at what readers say about breaks and workload.
Many GPs responding to the poll said breaks would simply mean they went home later. 'I choose not to take breaks in order to shorten the length of the day,' said one GP. 'I would rather work straight through than not finish until late in the evening.'
Another said: 'There is no such thing as a break or even lunch. Taking a break means you would be home even later with even less time with your kids. The work doesn't go away and in my experience it just follows you. You would have to leave your phone and the building.'
One GP said simply: 'Breaks simply add time to a day that is already 14 hours long.'
Our poll found that many practices don't take steps to ensure GPs take breaks. But even where breaks are scheduled in, GPs reported that it was often impossible to take them because clinics overran or there was no other time to carry out admin.
A GP said: 'Our practice makes a coffee break for the entire practice from 11-11.30am. But none of the doctors can attend except registrars - clinics run over - longer complex appointments and too many "extras"- mean my clinics (each single session) last 6 hours minimum! It's draining - a full day is 7am- 9pm - I can't speak when I get home.'
Another said: 'Even with allocated break times built into clinics it's hard to take a break due to either running late or having to deal with other problems during breaks.'
Many GPs responding to the poll highlighted the relentlessness of their workload.
'The work is unrelenting from the moment I get to the practice,' one GP said. 'I always leave in the evening with work unfinished, which has to be done the next day. I go in most Sundays to ensure that I hit the ground running on Monday. I try to have a 10-minute walk in the middle of the day but only achieve this twice a week. The only guaranteed break is going to the WC when no one can interrupt you.'
Another GP said: 'How do we take breaks when there is so much work to get through in the day? I now leave, if I can, at about 6.30pm/7pm because I am exhausted, but I only manage this by coming in at weekends and on my days off to finish the paperwork. It means there may be things that should ideally be dealt with on the day, but get looked at the next day, or a couple of days later.'
'Work load is barely manageable,' said one respondent. 'In 10 years of general practice this is the hardest I've had to work, 12-hour days with no break and then additional admin at home.'
One GP asked: 'What breaks? I see 40 people and speak to 30 on the phone per day - this is in addition to the paperwork and results and all the queries.'
Safety concerns and isolation
Respondents warned that the heavy workload GPs face put both GPs' wellbeing and the safety of patients at risk. 'The workload has become overwhelming and at times dangerous,' said one GP. 'On a typical two-session day I spend 11 hours in the surgery, no breaks, eating while driving to home visits or while filing blood results. It is unsustainable.'
Another warned that long periods working without a break left GPs completely isolated in their rooms, denying them contact with colleagues. 'It's all very well to say take a break but if you take breaks you are in til 8pm. The workload does not allow it. It's a lonely existence and everyone is working flat out in their rooms - I often don't see any other doctors for the whole day. I've worked at one practice as a locum for six months on the days [the partner] is in and he doesn't even know my name! There is no human connection with colleagues, or even time for a hello.'
What GPs have done to cope
GPs are increasingly deserting partnership roles to try to escape the worst of the pressure on general practice. Although some locums reported being unable to take breaks because employers expected them to work flat out, some GPs say locum or salaried roles have helped them control workload. 'As a locum I timetable in breaks and lunchtime. This means I am a far safer doctor than when I was a partner. Partners' work has an impossible "decision density",' said one respondent.
Another said: 'I have recently left my full-time partnership of 11 years for a part-time salaried role as the workload was overwhelming with no other way to manage it. My new practice is respectful of the need to take breaks and refresh in order to maintain good clinical care, as well as self-care.'
Others have limited their working hours. 'Because of the impossibility of taking a break during the working day, I now refuse to do more than one session per day. At least that way I am guaranteed a break after six hours work - I can go home.'
Some practices have made clear decisions to maintain breaks despite other pressures. 'Breaks for tea and lunch are vital for keeping the team together as well as clearing the mind after a difficult session,' one GP wrote. 'Nothing is so important it can't wait 10 minutes.'