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Gold, incentives and meh

Revealed: 11-hour days, 41 daily contacts and half of GPs working unsafe levels

Exclusive 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 say they should be, findings from Pulse’s major workload survey reveal.

Full-time family doctors are on average dealing with 41 patients in a day – when GPs said the safe limit should be 30, according to Pulse’s survey of 1,681 UK GPs.

Some are seeing far higher numbers of patients – around one in ten deal with 60 patients or more in a day.

Meanwhile, they reported the intensity of work was high, with GPs saying 29% of their patient contacts – a mixture of face-to-face, phone, online appointments and home visits – were ‘very complex’, and 37% were ‘fairly complex’.

GP leaders said the findings showed the profession ‘was working far beyond their capacity’ and warned the level of workload was affecting GPs' own health and posing a risk to patient safety.

Pulse asked GPs to provide details about their day spent in practice on Monday 11 February to reveal the workload pressures facing the profession.

The results found GPs’ 11-hour average working day comprises eight hours of doing clinical work, alongside three hours of administrative duties.

Around 51% of GPs said they were working beyond safe levels. 

The majority of respondents said it was a typical day of work for them, and some said they had made errors due to the volume of tasks they completed.

One GP who took part in the survey said: ‘By lunchtime I felt on the edge and risked missing urgent tasks and contacts, thus affecting patient safety. I did miss the fact that a patient I had tried to contact earlier in the day had called back, so I didn’t call her back before the surgery closed.’

Dr Matt Mayer, former BMA GP Committee workload policy lead, said: ‘The results of the survey done by Pulse are concerning, and confirm GPs are working far beyond their capacity.

‘GPs currently are making themselves ill in this job, and it isn’t sustainable.’

RCGP chair Professor Helen Stokes-Lampard said: ‘In my own practice recently, I had a 12-hour day and 100 patient contacts – GPs across the UK will tell similar stories.’

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.’

The findings follow a recent report on doctors' mental health from the BMA, which found nearly nine out of 10 GP partners are at high or very high risk of burnout.

BBC’s Panorama is reporting Pulse's survey results and investigating patient safety, workload and GP recruitment in its film ‘GPs: Why Can’t I Get An Appointment?’ on BBC One, 7.30pm, 8th May.

Additional reporting by Karl Tomusk


Related images

  • pulse gp workload logo 580x387px feb2019

Readers' comments (30)

  • Time to do what the rest of the developed World does and start charging Patients part of the cost

    This would reduce workload and increase funding for healthcare.

    Second we need to reduce bureaucracy. Abolishing Appraisal and Revalidation would instantly improve morale and free up the equivalent of 1000wte GPs.

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  • I'm sure the solution will be to have another survery in a years time and hope for different answer

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  • 11 hour days? Oh come on! that is only half an hour beyond standard opening times! As a Partner I did 7am to 9pm often, and saw others doing this to (not counting outside evening events like Rep meetings!)

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  • So another survey that informs us what those at the coal face already knew?

    See the usual NHS E tripe already issued on BBC Breakfast this AM regarding more in training etc etc

    Too little to late and just waiting confirmation figures regarding going 1/2 time ASAP and 0 time probably fairly soon after.

    Been in NHS since graduation in 8/86 and never been so keen to leave, 2 kids seen what its done to me and made the sane career choice of something else!

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  • Charges and penalties for DNAs should be brought in for patients.I am doing my blood test results on home. When someone is on holiday you get over 200. The current situation is already unsustainable especially with the current expectations and standards without increasing the work force and funding. Escalating risks for doctors with Gross Negligence Manslaughter charges will just push people to emigrate and do more unnecessary tests and referrals. It is only a matter of time before the system collapses.

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  • ‘BBC’s Panorama is reporting Pulse's survey results and investigating patient safety, workload and GP recruitment in its film ‘GPs: Why Can’t I Get An Appointment?’ on BBC One, 7.30pm, 8th May.’

    Because Communism.

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  • The usual NHS England none of extra support in General Practice.

    What they don't get is that for every extra allied health professional = more work for the GP because they can't take responsibility. Therefore risk and workload is siphoned to the GP.

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  • Eureka !! They still calculated that one GP is there for every 2000 which is nonsense. With 3800 patient we don't have funding even for 2 full time GPs. Research lagging or am I just coloured so my white British patients also need to be punished?

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  • Lifeboat- exactly. We dont need more people ticking boxes then referring to the GP when they run out of options. However when your own leaders vote against defining safe workloads and insisting they are met then what chance do we have

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  • @Big and Small
    The other perhaps more correct argument is
    'because capitalism'.
    If you continue to stoke up demand on a cash limited system it will eventually expire, allowing that majestic white horse of capitalism to ride in and 'rescue the day'. Now I wonder who's been in charge of the country for the last 9 years to make this sort of scenario more likely?.
    (I'm not a socialist or communist by the way, just someone who believes in fairness, equality and balance)

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  • @angus podgorny
    What codswollop - how can you talk about fairness or balance in the system ? It’s not capitalism that stokes the demand on the system- but socialism
    and it’s not a cash limited system- it eats huge amounts of cash- it’s just used stupidly ;as per other examples above- chris grayling etc- politicians cant run jack shit!
    It has run on doctors goodwill for years and when that was thrown in our faces, we voted with our feet and mass exodus follows.
    Black report clearly showed increasing health input in deprived areas did not change outcomes. wider system changes needed and individual responsibility / accountability
    - where’s Dr V Ho when u need him?
    People abuse the system and expect everything from it with no respect. it can’t be all things to all people- urgent care, as needed access for anything and health promotion/ prevention.doing job of failing / overloaded secondary care clinics. It has run on good Will for too long.
    there needs to be a clear acknowledgment we cannot go on funding things people WANT but don’t NEED - it was supposed to be free at the point of NEED! There is just no way of saying NO enough is enough.
    3 partners leaving in July as they are literally paying to work thanks to pension tax and falling profits etc..... and the tax penalty is already crazy.
    increase access and you increase demand.... it’s endless and corresponds to a total loss of personal control
    and I clearly remember Labour started the decline.... PFIs and the like, appointment meddling- .they’re no better than current crap.
    there should be no political meddling for short term gain in the nhs!
    After 26 years I’m out as soon as I can plan an exit strategy
    am drained and have nothing left to give.

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  • Maverick

    BBC Panorama 7.30pm "Why can't I get an appointment" cutting edge TV investigative journalism at its best...
    Take home messages;
    1. GPs average income £92,000.00 p.a.
    2. Child dies of ischemic bowel because GP misinterprets telephone messages and does not offer urgent/same day appointment.
    3. GPs in deprived areas don't offer enough appointments.
    4. 20,000 physios pharmacists and paramedics will save the day.
    5.One GP burned out under extreme pressure.

    Having watched the documentary I believe that the intended message in the broadcast is that GPs are to blame for not working hard enough. Patients need appointments and GPs are not meeting their demands.
    Conclusion for all GPs...
    You're on your own. Think for yourselves.
    Whatever you decide, with the wealth of knowledge you carry with you from your own training and experience you can at least look after those close to you.
    HMG, NHSE, RCGP, CQC, DHSC, HEE and on and on really don't give a shit.
    Stay if you wish.... leave if you can.
    Times... they are are a changin'

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  • We have been doing triage of same day requests ('urgent' in the patients' minds but usually not) for about a year. The receptionists rôle is key in that they get the basic reason when permitted from the patient, and from that the triaging doctor can fairly quickly decide who needs to be seen anyway, and receptionists phone them back, and who may be managed without face to face. To do this we have far more emergency slots and have lost a huge number of booked appointment slots, and that is the price the patients have had to pay - they can be fairly guaranteed to see a doctor today if they claim urgency, but if they want to see 'their' doctor they may have to wait weeks, and many do, adding problems to their list in the process. The patients are learning the rule of the penny and the bun - you can see Dr Anyone today, or Dr Popular in a month, but not Dr Popular today - yes Dr Popular may be working today, but then patients don't know that when they phone, and are not told. We encourage continuity of care for specific conditions follow up, (the doctors themselves make the follow up appointments) but traditional continuity of care where patients only ever see their own doctor started to die when we began to share on call, and cross cover for holidays, became terminal when we ditched out of hours, and died when part time work took off. I only ever hear about continuity of care these days when a doctor is trying to avoid seeing a patient.

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  • |Doc | GP Partner/Principal|08 May 2019 9:36pm

    Angus drops buzzwords like 'fairness and balance' to try and gain the moral high ground. If anything, its the total opposite. Fairness - is paying for what you need and use, how about that? Its the way it is run in the vast majority of the rest of the world lol Equality? Well everyone has access to healthcare, doesn't mean the minority of the population (taxpayers) should cover all costs for everything for everyone else. Especially, when done via 3rd party/the state. Balance? Ya, there's no balance when there's no free market force to balance the demand side of the equation. Or when the impression that the 'supply' is limitless.

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  • That in a nutshell is my point - supply is most definitely limited, and if you want more of one type of appointment you get less of the other. The current contract had lots of good things about it, but sacrificing so much time on the altar of preventative medicine, especially the low/no risk stuff like mild to moderate hypertension, primary prevention treatment of hyperlipidaemia and clinics for the unwilling asthmatics (75% of them), was very wasteful. True we as GPs are less involved now, but it still generates secondary appointments and lots of admin.

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  • @ Doc
    Increasing consumption (the fascination with GDP having to go up every year) is the very definition of capitalism, and in an unregulated way it is eventually going to screw much more than just our health service.
    I agree with you about the abuse of the system, I am a full time GP seeing this every day. But you will know as well as I do the effects of the media and politicians on patients with their 'you can't be too careful' and 'you can have it all now' approach.
    I fully agree with the want vs need approach and you are are right about the political meddling- if there were some way of devolving healthcare to a cross party system then there might be a longer term approach. The Scottish system although not perfect is much more consensual because of the proportional representation.
    Contrary to your belief PPI was started by John Major's Government. I agree with you that it is rubbish but remember that the NHS infrastructure had been run into the ground by many years of non investment and neglect by the time 1997 came around.
    I am sorry to hear about your partners. There are a lot of GPs up here too that are leaving or retiring early because pensions are not a devolved issue. You would imagine that a Government that actually cared about its people and the public servants looking after them would have acted on this by now, realising the harm that is doing. I hope you manage to recruit.

    @ Chis Ho. You state that the minority of the country are taxpayers are supporting the rest?
    Could we see some figures on that please? I assume that you are not including children?
    If what you say is in fact true then it is a terrible indictment of a system where there are millions of people who do not reach the level where they pay tax. If the poor can't pat tax then are you saying that they should not get healthcare? If they are on less than £11K per year then are you suggesting they can afford to pay privately? What is your solutions?
    Finally- I would give more credence to your comments if you were a practicing Dr in this country.

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  • It is always instructive to read Angus and Chris sparring. But as soon as I see the lines about "taxpayers funding this or that", I would urge you to have a quick look at

    Politicians can create and issue as much credit/money as they want. They just don't want to fund UK general practice

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  • Thanks Batman.
    It does make an interesting read. Post 2nd world war it is interesting that the US Govt spent it way out of economic trouble.

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  • Angus again misrepresents capitalism. GDP growth does not equate to GPD per capita growth. Although saying that, "screwing" up /changing a socialised, politicised, abused, health service is in my opinion, a good thing. I've asked Angus this a few times now. You see the misuse/abuse everyday from both patients and the state - yet you want to give them both MORE funds to misuse/abuse???

    Here's some of the evidence:

    There's more evidence and the interesting bit is how we compare globally.

    Angus, your 'indictment' of the system is false again:
    Its not a zero sum game. The reasons why lots of people do not 'reach the level' of paying tax, are that the state is too big -- smaller economy. The tax burden is by global average, sizeable -- smaller tax take. You betray your ignorance of economics and history. Well, all socialists do.

    I've never said the poor shouldn't get 'healthcare', I'm fine with emergency treatment and maybe access to primary care provision. Everything else, should be an individual's responsibility in life - just as it is in most of the rest of the world.

    I've also said before, I do practice in the UK. Its ironic you question my credibility, whilst hiding behind a persona.

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  • Batman, that article you referenced is BS. It's waffle trying to disassociate federal govt from its reliance on federal taxpayers. However, you forget the primary role of the US federal govt as stated in its Constitution.

    Sure, a state can print and issue as much credit/money as it wants. However, we all know what happens when that goes overboard. And I believe, the population (We, the people) are less ignorant of the processes by which the state works. More so, when the state seems to be doing a sh*te job (e.g Brexit).

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  • There are no Christopher Hos on the GMC website who are currently registered. How do you manage that then?

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  • Simple, I might not be registered with the GMC with that name. I fail to see why I'm having to justify my credibility to you though, a pseudonym without even a name up, who sounds like a Labour schill.

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  • I suppose when you can't counter the arguments I brought up, you go for the man instead of the ball, and try and dox me. The more you try and do so though, the more you lose with the readers, so the more I win. I almost want you to keep at it lol

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  • '29% of their patient contacts were... ‘very complex'

    I think that seems to be even higher where I work. All the Nurse Pracs get the cases where I would usually catch up or breeze through with relative ease.

    Means I'm then left with 16 often extremely complex patients per session, and the issues that raises. Often complicated even further by the fact that people will come with lists (and the unrealistic expectation that that their issues will be sorted out immediately without any issue).

    I often feel now more like I'm expected to have the knowledge of an acute medicine/gynae/paeds/psych/Ortho/renal/neuro consultant, yet with a fraction of the time/investigations or treatments available to said consultants.

    No wonder we are feeling overwhelmed...

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  • @Chris Ho
    Previously it was you who played the 'man and not the ball' first when you criticised me and my colleagues on here for hiding behind avatars. It would seem that you are doing exactly the same.
    That is just rank hypocrisy is it not?

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  • @ Angus - Well you would know hypocrisy wouldn't you lol I'm not hiding behind any avatar. Are you denying you're not an avatar? My GMC registered name is simply not the same as the name I go by here. The only reason I criticised you was when you brought my credibility into qsn. I wouldn't have done so otherwise and have otherwise focused on the points you bring to the debate.

    Nice of you to ignore all of my other points and questions to focus on this issue, and also not volunteer your name for me to check your registration too. You want to do this on equal grounds? Then lets have your name.

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  • The GMC allow you to use a different name from your real name do they? Wow.
    How can I apply for that?

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  • I don't have to explain to you how its different when you refuse to address my points or meet me halfway. The reading public can decide who's credibility they rather side with.

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  • Fair enough. We'll let the millions decide.

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  • @Angus - I'm sure they'll give more credence to what you say if you actually named yourself, much less show that you're actually in the medical profession AND practicing in this country too.

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