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Independents' Day

GPs more likely to work 10-hour shifts at larger practices

GPs working in practices with larger patient list sizes are more likely to work longer clinical hours than those based in smaller practices, according to the results from Pulse's major workload survey.

GP leaders said at smaller practices GPs were more likely to be familiar with patients - and could therefore offer better continuity of care, which avoided adding to workloads.

There has been a perception that health authorities are favouring upscaled practices, aided by the revelations in Pulse that the former NHS England medical director, Dr Arvind Madan, said GPs should be ‘pleased’ when small practices close.

Pulse's survey revealed almost a third of GPs (31.6%) working in practices with 10,000 or more patients reported completing 10 or more hours of clinical work on the day of the snapshot survey, Monday 11 February.

At practices with 7-10,000 patients, 29% of GPs completed these longer hours, compared with 23.9% of GPs at practices with 3-7,000 patients, and just 12.5% at practices serving up to 3,000 patients.

Tower Hamlets LMC chair Dr Jackie Applebee said: ‘Governments across the UK are moving towards bigger practices through networks, clusters or federations. Yet the survey reveals GPs in larger practices are more likely to work long hours.

‘I work in a small practice and we all know the regular attenders and more complex patients. If a complex patient has to see a different GP each time, that might add to workload.’

Walsall LMC chair Dr Uzma Ahmad added: ‘On funding, the Government thinks it’s better for a bigger practice, but for patients, smaller practices provide more continuity of care.’

In response to Pulse's workload survey, an NHS England spokesperson said: ‘We already know that general practice is under pressure which is why investment in local doctors and community services is increasing by £4.5billion, helping fund an army of 20,000 more staff to support GP practices as part of the NHS Long Term Plan.

‘But we are also aware that almost nine out of 10 salaried GPs currently work part time.’

Pulse's survey findings are based on responses from 1,681 GPs about their day spent in practice on Monday 11 February.

The results showed more than half of GPs say they are working above safe limits, on average completing 11-hour days and dealing with a third more patients than they believe they should be seeing.


Readers' comments (12)

  • I think the NHS England comment about part time working is outrageous. Many salaried GPs and indeed partners make a life decision about the hours they work and implying that they should work more, which would likely lead to a mass exodus, is ridiculous.

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  • Nhsfatcat

    We need to define part time against the average working week of most people; or, even better, against those that work in safety critical roles. I suspect a six session GP averages 40 hours after adding in training, additional hours and extended access projects.

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  • It is obvious / common sense that knowing your patients well improves efficiency and continuity.
    On top of that patients want GP patients that offer personalised care . This is best delivered in small practices rather than the latest vogue for large mega practices . Fewer complaints.

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  • If they want more pay more pay per activity not the lousy capitation model.Reward excess work rather than bully browbeat and black-mail NHSE.

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  • pilots do one flight per week

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  • long haul that is

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  • Multiple points of contact, whether that be multiple GPs, ANPs, OOH or clinical pharmacists adds to the patient churn.

    Churn is not in the best interest of patients nor an efficient health service. It’s the division of a problem into 3,4 or more separate problems- each dutifully attended to by a different healthcare professional. It adds to the confusion experiences by the patient and magnifies the problem- it creates new problems.

    We need to move away from more illness identification and modelling health around disease promotion but it takes a relationship, trust and understanding of the person before you to do this. A 10 minute fumble with someone unfamiliar does not lend itself well to this. Continuity of care is a necessity and is sorely lacking in today’s drive-thru style medical world.

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  • A full time teacher averages 24 contact hours with pupils. But still work 10 hour days. In France a full time teacher has 18 hours contact with pupils.
    Sessions seeing patients is not a measure of part time or full time. It is hours worked.

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  • Need to move to Canadian / Oz model with 600 or so patients per GP with Co-payment...loads of time to cover everything..and higher income

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  • Unfortunately Tony Canada can afford to, it's GDP per capita is $51,546 whilst the UK's $45,565

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