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Workload survey: 'We are working beyond the safe level'

Lincolnshire GP Dr James Howarth describes the strain his practice is under due to rising workloads 

'We have an average-sized practice list of about 7,500. The demographic is slightly above normal in terms of age and deprivation and we’re rural – which is a big factor. I was duty doctor on the day of Pulse’s survey, and I had 124 patient contacts. The median is about 60-70 – beyond a safe level.

'Patient demand is not the only factor affecting workload.

'A lot of it is the workload dump from secondary care: decoding illegible handwritten prescription requests; consultants sending patients back to us for referrals to their colleagues, and without giving us the relevant information; chasing up referrals when the patient has heard nothing and can’t reach the secondary care team; and dealing with late or inadequate discharge letters.

'This workload creates patient safety risks. There are risks around having multiple patient notes open because we’re helping a nurse out with hers, or we’re 30 minutes late so we see the next patient while finishing the notes of the last.

'We might forget consultant details, plans and actions, or prescribe for the wrong person, use the wrong labels on blood tests, and so on.

'And the high number of consultations means we haven’t got enough time to deal properly with patients. So, for example, heart failure patients don’t have their medication titrated up, and those with complex combordities aren’t adequately managed.

'Just this week I sent a blood test using the wrong patient details, simply because I was so busy that safety netting didn’t happen. I spotted it in time, but how many do we fail to spot?

'I have raised safety concerns with governing bodies before. I was basically told to shut up or my practice would be run over with a fine-toothed comb.'

Dr James Howarth is a GP in Spilsby, Lincolnshire.

He took part in Pulse's GP workload survey, the results of which have shown GPs are dealing with more patient contacts than they deem safe.

Readers' comments (2)

  • Why is it we are the only industry that isn't allowed to create safe working conditions by limiting workload, then have to take the blame when errors occur? The RCGP/BMA is failing here.... we are the professionals and should be advising the government what to do, not the other way around...... if I were in charge of the RCGP id want to know in confidence who had made the overtones and would encourage all GPs to record, covertly if necessary, all contacts regarding safety to clarify the picture here and ensure that if an error occurred after reporting of workload issued that the bodies, individuals who are trying to ignore these safety issues are publicly named and included in any litigation where error occurs. RCGP should be on the offence here, if they are responsible for GP standards as they say they do on their website, they're not supposed to be here to cosy up to other organisations.... ..... standards include safe working conditions for patients and doctors alike. If NHS England is making this impossible, then perhaps we should be taking legal action against them on the basis of knowingly creating unsafe working practices? We should insist that GPs withdraw their service from unsafe practices. Perhaps we need to enlist the aid of the media here, e.g. Panorama to investigate those in charge of these organisations and look at how their performance compares to other safety related industries. We have to up our game and become more media savvy, you can't make an omelette without breaking eggs.... if there is not enough resource to provide a safe service then the government needs to say so... and take appropriate damage limitation measures... e.g. statute of limitations..... is there anyone else out there who feel there safety concerns are being ignored? Another great area for Pulse to Investigate.....

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  • Spot on curious.

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