A 'tsunami' of work is drowning general practice: GPs speak out about a profession at its limit

Rocketing workloads created by huge backlogs of cases and continuing COVID-19 disruption have left GP teams ‘absolutely exhausted and demoralised’ - with many questioning how long they can work at current levels and fearing a workforce exodus.

(Photo BraunS/Getty Images)

Family doctors told GPonline that they were dealing with a ‘tsunami of cases’ as patients come forward with health issues they have stored up over the past year - resulting in clinicians working 70-hour weeks.

GPs said that increased volume and complexity of consultations had forced them to prioritise the most sick, with many highligting that the past three weeks have been the busiest ever.

Official figures published last month revealed that practices in England delivered 28,570,000 appointments in March this year, compared with 23,720,000 in February - a 20% rise.

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GPs revealed they were fielding numerous calls about the COVID-19 vaccine following blood clot fears - and have had to handle more secondary care work amid disruption to routine services during the pandemic.

Clinicians have also warned that unsustainable work levels have already forced colleagues to reduce their hours or take early retirements - they fear more could follow without intervention.

Surrey GP Dr Dave Triska told GPonline that staff at his surgery had faced an ‘astronomical volume' of work since Easter. He questioned whether it was ‘humanly possible’ for teams to continue at present levels.

Complex consultations

He said: ‘I would describe myself as a very efficient worker. During extremely busy periods, like Christmas, I normally get away at 6:30pm, maybe 7pm at worst. But over the last three weeks I've been leaving the building at 8:30pm – having started at 7:45am – because the volume of work is just astronomical.

‘I have been a GP since 2014 – and I was deployed to Afghanistan in that time – and this is the hardest I've ever worked. Because we are making multiple, complex decisions throughout the day there is just a mental limit...it can't be sustained.’

Dr Triska revealed that 15% of the work carried out by his team in a week related to delays in secondary care, with the practice managing patients waiting for hospital services. He argued that this was challenging to handle on top of a large primary care backlog.

‘Last night I was nearing the end of the day at 6:30, obviously still two hours ago, and I was trying to chemically cardiovert someone in atrial flutter in a GP practice. That's not something you would routinely do. It's just extraordinary,’ he said.

Partners retiring

The Surrey GP also said that the quality of care offered to patients had suffered in recent weeks, saying that his team had to focus on ensuring care was safe. He added that two out of six GP partners at his surgery were retiring early as a result of the current pressures.

‘We're losing a third of our general practice workforce, with 50 years combined general practice experience between them - how is that going to be replicated across the country? This next year, not only will it be GPs [leaving but] practice staff... other practices are hearing the same, receptionists are exhausted and tearful at the end of the day, nurses as well.’

Dr Neena Jha, a salaried GP in Hertfordshire, said there had been a ‘huge jump’ in workload over the last two or three weeks. She explained: ‘Predominantly what I'm seeing is a tsunami of cases from the backlog of the whole year. So a lot of patients who postponed or held onto their problems in the first wave or even during the second... are only coming forward now.

‘You've got all that backlog of the routine care, or the chronic conditions that are coming forward, and often now the symptoms have become more complex or more severe. So they are just taking longer to deal with.’

COVID vaccine questions

Dr Jha said that her practice had fielded a high number of calls about the COVID-19 vaccine, which had added to workload pressures. 'We are getting a lot of patients who want to know if they are eligible for the vaccine, or people who have had the vaccine, the AstraZeneca jab, and are asking about headaches post vaccine… [some] have read about blood clots and they're concerned.’

Dr Jha is contracted to work two sessions, eight hours, in general practice each week. But she admitted that this was more like 12 hours due to current demands. 'A couple of Fridays ago I was on call and I had about 70 patient contacts that I dealt with solo. After that you are trying to clear the backlog from the day, and that doesn't include any of my paperwork, which I usually catch up with on the weekend - and that's not paid,’ she said.

The Hertfordshire GP reduced her hours in August due to childcare commitments, but she said that collegaues had cut down or left due to burnout or for mental health reasons. She said staff were ‘absolutely exhausted’ and felt ‘very demoralised’ because they can’t ‘do as good a job’ as what they would like.

‘I do think it's simply a case of demand outstripping capacity. We have lost 19% of our GPs in the last five years, so there's just not the capacity to meet the huge demand coming through. The burden is spread upon fewer and fewer shoulders, and it's just going to perpetuate,’ she said.

GP exodus

Recent BMA polling found that more than a third of UK GPs plan to retire early and many more to reduce their working hours in the coming year as unmanageable workload and the pandemic leave the NHS facing a 'ticking timebomb'.

East London GP partner Dr Selvaseelan Selvarajah told GPonline that colleagues were finishing late everyday and working at the weekends to keep up with demand. He said workload was 30% higher than normal rates.

He said: ‘As a practice we offer over 1,000 appointments a week and usually that's enough to meet the demand. But lately that hasn't been enough, and that's why we've drafted in extra clinicians. As a GP partner I have a vested interest in my organisation, so I thought it would push on with it for a while. But my team is saying it's the busiest it's ever been.

‘One of my partners who works Monday, she's logging in on Sunday, and having a chat with the reception to allocate and triage the patients for Monday so they can be booked into the right slots. This has never happened in the last 10 years.'

Additional roles

Dr Selvarajah added that the whole general practice team was busier than usual, including additional roles staff like pharmacy technicians. He said: ‘They take a lot of the work we used to do, such as repeat medications, processing documents that come from the hospital, reconciling medications.

‘They are just incredibly busy doing things that secondary care would have previously done, or being asked to initiate medications that would have [been signed off from secondary care.] They also sift through all the online consultations and then they push them towards the doctors, so they're also incredibly busy as well.’

The NHS Confederation's PCN network recently argued that primary care teams need a clear plan to help them manage growing workloads and protect staff against burnout and guarantee safe patient care.

Meanwhile last month RCGP chair Professor Martin Marshall warned that there was an urgent need to develop a comprehensive plan to keep GPs in the workforce, which addressed problems around workload.

'We urgently need more GPs and other members of the practice team to manage increasing workload in general practice,' he said. 'Good progress has been made to encourage medical students to choose general practice, but we also need to see comprehensive plans to keep existing and experienced GPs in the workforce, protecting them from burning out by addressing "undoable" workload.'

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