This site is intended for health professionals only

At the heart of general practice since 1960

pul jul aug2020 cover 80x101px
Read the latest issue online

Independents' Day

My message for 2015? GPs must stop working 14-hour days

In a recent speech, I told colleagues that I felt current arrangements for GP training would never release the necessary number of places needed to bolster our workforce. Some remarked afterwards that the problem wisn’t places, so much as the fact that young doctors simply don’t want to become GPs at all.

Unfortunately, I agree with them. They were perfectly right. 

Lack of resources, people and increasing demand have led to unmanageable 12-14 hour working days. This has repercussions on our effectiveness, home life and job satisfaction.

It also leads to GPs wanting to retire early and young doctors not wanting to join general practice. It is not only bad for GPs and general practice, it is also bad for patients and the wider NHS. I warned of a fracture – for the first time in my professional career – between GP and patient, with the former being asked to do an unmanageable job while our patients are led to expect ever improving access and a wider range of services.

GPs must stop trying to be heroes. Under current arrangements, GPs who work 14-hour days do so because going home on time feels like shortchanging our patients.

Our profession is being morally blackmailed. Like a person thanked for handing out Christmas gifts another person has bought, the Government has taken the credit for the generosity of UK GPs. Meanwhile the comparative funding of general practice has slumped from 10% to 7.5% over the past five years.

Tackling more demand and more work with fewer people, fewer resources and less finance isn’t sustainable. 

The usual solutions - golden hellos and handcuffs - will be wheeled out, but to no avail.

So our urgent task must be to reverse the the erosion of status and confidence in general practice (not to mention our funding and manpower).

Workload cuts

Now, only a major action could address the problem - a Commission on General Practice and the launch of high-level national task groups for reducing bureaucracy, for example. But we must have more hands on deck - particularly recruiting staff such as senior nurses, who previously integrated the care of our housebound elderly with access to health services, social services, voluntary and volunteer services. 

Then we must get rid of payments for diagnosing dementia (rather than doing anything about it) and stop writing overdefined care plans (rather than caring). Our mission to care for patients and communities is constantly diluted by workload pressues -  from having to lock up your practice stamp for CQC (and in my case, invariably losing the key) and remembering three practice computer passwords, which change each month, to yearly mandatory training on safeguarding children, adults and confidentiality. Little wonder my colleagues lose hope and retire early.

However, the darkest hours come before dawn. I feel NHS England realises at last that things really are desperate. It must know that improved manning and resources are needed, and general practice is key to a sustainable NHS. The monies for GP premises funding and the Transformation Fund are the beginning of that much need cavalry to get general practice back on its feet.

But we need to act, stand up for ourselves and deliver quickly if we are to avoid becoming salaried serfs on the front line of ‘integrated’ organisations led by Foundation Trusts. 

Now, more than ever, we need to stand our ground. Turn cynicism and despair in to determination and hope for ourselves and our patients, and end those 14-hour days.

Dr Michael Dixon is the chair of NHS Alliance, a senior adviser to NHS Clinical Commissioners and a GP in Cullompton, Devon.

Rate this article  (4.77 average user rating)

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Readers' comments (15)

  • I respect the fact that mike dixon has a direct line to senior people in NHSE.

    Can Mike Dixon publicly say if he trusts them enough to put his reputation on the line?

    Is there really going to be a dawn? or should we all be looking to emigrate?

    Unsuitable or offensive? Report this comment

  • Peter Swinyard

    Spot on, Michael. Indeed NHSE are starting to listen to our pleas on reduction of bureaucracy.
    I have not seen any positive outcome for writing care plans for our 2% club and doubt I will.
    We need to rekindle the passion so many of us still have for the core part of general practice - the long term therapeutic relationship with our patients and continuity of care. We have to explain to younger doctors that working in one place for a full career can be professionally and personally fulfilling and we have to create a system in which we are not swamped by demand.
    The causes of the present troubles are multifactorial and not all down to the unjustifiable reduction of resources as a percentage of NHS spend. Perhaps the multitude of portals into primary care (us, walk in centres, out of hours centres etc etc) are not adding value. Shut the lot, I say, and reinvest the money into general practice (NOT primary care - they are not coterminous). Change our contract to give us back the control of the out of hours period (but not make us the doctor of last resort). Help us redeploy some of the excellent nurses who work in walk in centres etc back into general practice and finally, most importantly, embark on a major public education programme of self care and appropriate use of a scarce and limited resource.
    OK, Happy Christmas to all, I now need to get on with my morning surgery!

    Unsuitable or offensive? Report this comment

  • Blah blah blah. Talk talk and more talk. Until we have the balls to walk away and practice primary care for a proper fee then nothing will change. Not enough GPs to fulfil the demand for service that has been created by offering the all you can eat buffet style of medicine.

    Unsuitable or offensive? Report this comment

  • Moronic 14 hours a day!? EWTD?! Shouldn't we all be in Goal for breaking this European law? NHSE would then HAVE to do something and as it couldn't be OUR fault it would have to be THEIR fault, even in the pages of the daily snail.
    What happens in the airlines when the pilots are pushed to do longer hours?- plane crashes? - pilot error or corporate murder? 5 year plane (sic).

    Unsuitable or offensive? Report this comment

  • Peter Swinyard

    I went to an "educational event" on risk reduction put on by my defence organisation last year. Run by an ex-pilot who thought all problems would be solved by a group hug with staff at the start of the day and running to protocols. Ridiculous hours and unbridled demand make that kind of thing slightly at the edge of credibility. My pre-flight check is limited to "is the computer running?" and "is there coffee?"

    Unsuitable or offensive? Report this comment

  • The one thing aviation safety analysis does teach that is of value is that the first two links in a "chain of disaster" are
    1) High Cabin Workload Pressure
    2) Toleration of Poor Standards.

    If the ammount of resource beiong commiteed to external removal of "toleration of poor standards" was spent on reducing " cabin workload pressure" the NHS would have GP's.

    Unsuitable or offensive? Report this comment

  • we should be walking away from the government because this is going to be an intolerable endless cycle of boom/bust.

    Look at the economic, political and financial freedom from NHS dentists. GPs being responsible for 90% of NHS workload can easily break away and accomodate such a model - taking a mix of private and NHS patients. We need to do it for the sanity of our staff, the future of the profession, and as a result the future of the NHS.

    Unsuitable or offensive? Report this comment

  • Is Dr. Dixon brave enough to tell all he has written to the governent ?

    Unsuitable or offensive? Report this comment

  • If you're working 14hour days, then you're doing it wrong!

    Unsuitable or offensive? Report this comment

  • Mike Dixon is absolutely right. Doctors cannot continue to work for as long and as hard. Today was my last day as a partner. I resigned at the age of 56 because the figures no longer add up, and it is rarely possible to go home having finished the work any more. The cuts made to our funding have put the future of the practice in jeopardy. General Practice has become the dumping ground for everything that none else wants to do without the funding flowing in our direction. I am so sorry, but I have had enough of the stick and the carrots are no longer plentiful. For the sake of my own health it was time to go.

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page

Have your say