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GPs buried under trusts' workload dump

​GPs have almost twice the safe number of patient contacts a day

Exclusive GPs in the UK have an average of 41.5 patient contacts every day – 60% more than the number considered safe by European GPs – Pulse can reveal.

A survey of 900 GPs reveals that more than one in five GPs have more than 50 daily patient contacts, including face-to-face and telephone consultations, home visits and e-consultations.

Some GPs said they had up to 70 patient contacts a day – with others saying that the pressure has forced them to resign or give up partnerships.

However, a leading European GP forum has recommended no more than 25 contacts a day.

The BMA's GP Committee called for a limit to the number of consultations a GP carries out each day in its Urgent Prescription manifesto for general practice last year, but nothing has come of it.

A Pulse investigation last year revealed that patient demand is increasing at the same time as the number of GPs is decreasing – meaning GPs will have to work an extra two hours a day to meet demand by 2022.

The comments from GPs suggest that they are seeing an unsafe number of patients. They include:

  • One GP in East Anglia, who said a typical day included 42 contacts with 30 or calls as duty doctor in the afternoon, which could soar to 50 plus phone calls on ‘bad days’. They added: ‘I have actually tendered my own resignation as it is making me unwell to work at this pace.’
  • Another doctor, who reluctantly left 13-14 hour days as a partner for a more manageable workload as a salaried GP and 31-40 daily contacts and told Pulse: ‘I felt I was at a risk of making mistakes and causing potential harm to my patients and my career.’
  • One GP told Pulse that on one exceptional ‘horrendous’ Monday he had 71 contacts. Since then the practice has since increased the number of on-call doctors on Mondays to three.

GPs reported that dealing with letters, lab work, repeat or acute prescriptions and referrals can mean they are dealing with case work for five times as many patients as they see.

Shropshire GP and vice-president of the European Union of General practitioners (UEMO) who has surveyed doctors across the continent said: 'Around twenty-five contacts is safe.’

She said the higher numbers of contacts in the UK ‘is pretty dreadful’. She added: ‘I think GPs have little insight into how hard they are working.’

Dr McCarthy said: ‘The demand is fuelled partly because patients are pushed to the GP for any problem there is.’

She said doctors across Europe told UEMO they 25 contacts was suitable, with 25-30 minute appointments as standard in some countries.

The BMA voted at this year's Annual Representative Meeting that there should be a set limit of GP-patient contacts per day, but did not vote on a number.

Dr Richard Vautrey, BMA GP Committee chair, said: 'We know that unmanageable and unsafe workload is the primary reason behind doctors leaving general practice, which is leading to serious issues including practices closing to new patients and other surgeries closing entirely. This workload pressure also means GPs are increasingly suffering from burnout and patients are being put at risk of unsafe care.

'The BMA has called for practices to be empowered to set their own capacity limits for safe working, which includes limiting the number of consultations per day. Fewer consultations would mean longer contact time with patients, leaving doctors better able to ensure safe, high-quality care, that many feel is not possible within the current 10-minute consultation.'

Professor Helen Stokes-Lampard, chair of the RCGP, said: 'This survey backs up what the College has been saying for years – that many GPs and our teams are regularly working way beyond what could be considered safe for patients, and potentially jeopardising our own health and wellbeing.

'GPs expect to be busy, and we are making more consultations than ever before as we strive to deliver the best possible care to all our patients who need it, but the workload at the moment is relentless and it’s taking its toll. The GP health service in England was launched earlier this year, and there are already more than 1000 GPs on its books.'

Survey results in full

On average, how many patient contacts (including consultations, telephone, home visits and e-consultations) do you have in a full day in clinic?

0-10: 1%

11-20: 3%

21-30: 9%

31-40: 37%

41-50: 29%

51-60: 13%

61-70: 4%

71-80: 2%

81-90: 0.5%

91-100: 0.1%

More than 100: 1%

Don’t know: 0.3%

The survey was launched on 10 October 2017, collating responses using the SurveyMonkey tool. The 25 questions asked covered a wide range of GP topics, to avoid selection bias on one issue. The survey was advertised to our readers via our website and email newsletter, with a prize draw for a Ninja Coffee Bar as an incentive to complete the survey. A total of 899 GPs answered this question.

Readers' comments (45)

  • So much to say... Pulse Editor...
    First and foremost I have a concern and I hope Pulse have a mechanism.
    So many conversations I read here and attached to other articles are a descriptor of extreme distress and the symptoms and signs of this are all too evident.
    I do hope that PULSE and the individuals who write comments here are aware of this and signpost or self signpost to get help.
    PLEASE PLEASE get help... whatever that might be
    Second. Jonathan.... thank you. I come from a self management skills training background and your words resonate strongly with me. You can alter your populations illness behaviour and your speed/balance and joy in your work is a reflection of how that can function - I am sure you apply many other skills. These are the transferrable and teachable skills I was alluding to but we have as an NHS community only touched the surface as the personalisation and self management agenda has never been taken to a scale where you see wholesale shifts in societal behaviour - patient activation. It can be done but requires a sustained national initiative over 10-20 years plus which is left untouched to see the fruit of the labours... takes courage to make this commitment. But courage is what we need.
    Finally I also agree that patients self select and that this is a challenge and also a reality (where personal lists don’t exist). I have long said that, crudely speaking, there are two types of GP. One that generally thrives on and excels in acute rapid turnaround consultations and others who thrive/excel on complexity... the consultation length, approach and management is very different. Clearly there are some who do both just fine. In our complex world we need to accept we need to not see the consultation as a fixed 8.2 minute format and that we should match consultations between the patient type/need and the particular style of GP. We should also accept this working alongside our different colleagues.

    But again I say to those suffering out there who feel like running away... make sure the first thing you do is run to get help, support and care. Don’t suffer in silence... Start to put your Safety Plan together now.. I have had mine for a long while now
    TimeToWakeUp

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  • How we see patients has changed. You cannot see a patient in 1 minute if you are a doing their observations and examining them thoroughly, and if one of the patients deteriorates then it is now expected that there are observations recorded to prove this- or to prove they were ok when you saw them. This is defensive medicine, but in the current litiginous and blame culture , it is required.
    So, this is why we can only see a fraction of the amount of patients.
    Before I changed my practice- which has been a gradual thing- I could have seen more patients. I am not aware of a single patient who had suffered from my previous method- most doctors can tell at a glance which patients need a more thorough examination- but todays culture has changed. No one can predict which patient may get worse.
    We are not allowed/expected to refer as soon, we are discouraged from sending to a+e- indeed many patients who have perfectly sensible reasons to go to A+ E now come to us to be assessed.
    We can employ more clinical staff to help us, but then our income is reduced substantially and then when older partners leave , you get no one interested in the job.
    What on earth is the BMA and the RCGP doing. I think we should all stop giving them a penny of our money, they are useless to us. In fact I think they are responsible for many of our problems.

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  • Jeremy Hunt rants on about wanting the safest health service in the world whilst ignoring the day in day out crisis of demand exceeding supply in every aspect of the NHS. I never imagined how many patients i would be seeing a day now when I qualified as a GP in 1999. decisions made at such a pace involve risk to patients and risk to the doctor, its a crisis every day and I don't think I want to do it much longer but if I dont and our colleagues think the same, who will?

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  • The present system is a joke. I will look forward to leaving the uk soon. Mr Hunt needs to increase recruitment from wherever he can ! I hear Nigeria, the Carribean and Asia are cheap options. But wait! These doctors need to get work visas first and they may struggle owing to the low pay they are expected to get...dumb system :/

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  • At least Jeremy Hunt IS concerned about the outcome of the recent GMC hearing case - as he should be...it overlaps with the sircumstances of overwork and the risks associated with it...
    The realisation of the effect of this is surely:
    A reduced number wanting to join the profession
    A number much more rapidly leaving the profession in the UK
    A reduced number working into goodwill
    An increased number working to rule
    A reduced number documenting reflective practice
    An increased number practising defensive medicine
    An increased number reporting failings in workplace and conditions BUT not holding out much hope for change...
    Whilst Brexit reduces visa freedoms of overseas doctors
    With the undercurrent of fear that all healthcare professionals are at risk of manslaughter charges
    Not the best state of affairs for retention and recruitment really

    But I might have misread the situation... is there an action plan anywhere to address this which is not simply about ... let’s put more money into the NHS
    So much of this is hearts and minds stuff where compassion, support, hope, much more good sense and a feeling that you are not alone is vital...
    TimeToWakeUp?

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