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GP sees 84 patients in one day

A GP was forced to field 84 patient appointments in one day last year as the 2013/14 GP contract imposition created an untenable workload.

The Holbrooks Health Team in Coventry submitted a workload report to the local area team of NHS England which showed that one GP undertook 84 appointments on 1 August 2013, and revealed that a GP had seen more than 60 patients in a day on 34 different occasions over the two-year period covered bu the report.

The practice blamed the imposed changes to QOF for a rapid deterioration in the availability of appointments and concluded that it may have to drop chunks of QOF work related to long-term conditions such as diabetes because it was loss-making - threatening instead to refer all to hospital as outpatients.

Dr Ken Holton, one of the GPs at the practice, said: ‘This was an internal analysis performed by the practice concerned because appointment availability declined from very easy to terrible - despite the introduction of telephone appointments, which made it worse - just in the space of a few months, associated with the QOF changes to shorter intervals and higher targets.’

In concluding the report, the practice said: ‘The diabetes element in QOF already costs more to perform than it produces in revenue. The proposed “bundling” of indicators renders the disease unsuitable for delivery in primary care and all patients with diabetes should be referred to hospital for treatment with immediate effect.’

However the practice has opted against taking up the recommendations in full after discussions with its patient group.

Dr Holton said: ‘The recommendations were those proposed by the doctors for discussion with the patient group representatives and the NHS England Area Team. That meeting was in March, since then a new appointment regime has been drawn up and may be implemented in the next couple of weeks.’

‘The diabetes workload was given a thumbs down by the patient group who said they didn’t want to go to the hospital all the time. We have slightly increased our referral rate however.’

It comes as an RCGP poll showed many GPs are now working 11 hour days with 60 patient appointments in one day.

Readers' comments (9)

  • Only 60 ?

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  • Bob Hodges

    Including telephone calls and non-simple repeat medication request I frequently deal with more than 80 people in a day.

    That's the equivalent 4.5% of my patient list interacted with in a single day. Extrapolate that over a year, then consider the average funding that each patient brings in per year.

    Someone's getting mugged.

    I think it might be me.

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  • Dr Mustapha Tahir

    This high consultation rates is neither in the interest of the Patients' nor the Doctors healths and morale. The MDDU has already shown a correlation between high consultation rates and increased reporting of Doctors to the GMC.
    Mustapha Tahir
    @MustaphaTahir.

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  • 84 patients (840min) is that face to faces because thats 14 hrs of consulting in a row - that cant be right! How much of that is minor illness? I would guess a lot. Once you federate you can train up a pot of mobile minor illness practitioners to do it for you. You cant carry on like that without combusting into charred carrion.
    Bob - how do you surpass the 80mark ? Why don't your ANP's deal with the staple and leave the more complex/challenging cases to you?
    There's ways around this - educating patients - if anyone interested my colleague has helped make this leaflet for parents who bring their children in whenever they have a cough;
    http://www.oxfordshireccg.nhs.uk/wp-content/uploads/2014/05/child-health-booklet.pdf

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  • Profit per consultation face to face is £ 10. If you factor in paperwork at 40 % it is £ 6.00. the Govt takes back £ 3.00 in tax, NIC etc.
    Take home is £3.00. This is for 40 appointments per day.

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  • Soft option is to Reduce the list size ,reduce risks and let the A&E take the risks.

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  • And with fewer GPs in training, many current ones reaching retirement, and an increasing population - this isn't looking like it's about to get better is it...?

    "Soft option is to Reduce the list size ,reduce risks and let the A&E take the risks."

    I can understand the sentiment, but I really hope no one considers that. It's simply passing the pressure on to equally over-stretched A&E colleagues, and will result in more hospitals over-capacity and unable to admit emergencies. Thus patient harm.

    I'm not claiming I've got any answers though. Other, that is, than increasing NHS funding to the same levels as Switzerland or Norway. Or even Holland, Germany or France. Instead of spending it on illegal invasions and nonsense like HS2.

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  • don't expect the hopelessly unfit for purpose unaccountable quango called nhse to listen to logic...they clearly demonstrate frpm their actions little real interest in patient care despite the endless pathetic platitides.(.they are the prime reason for the workforce crisis and are an absolute shower.

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  • Why isn't anyone looking at whether or not those 84 patients actually needed to see a GP? Was there maybe something done wrong by the practice in encouraging patients unreasonable health seeking behaviour (if this is the case)...what about the patients..had they already been seen by GPs for the same problem? Were they given unnecessary follow up appointments?

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