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UK doctor leaders back calls for workload cap 'to protect sanity of GPs'

Doctors from across the UK have backed calls for the introduction of maximum workload limits for GPs.

The BMA's Annual Representative Meeting voted in favour of a motion urging that a 'sensible cap is agreed on the workload that a GP can be expected to be safely deliver in a day for the safety of patients and sanity of GPs'.

This follows last year's vote in favour of introducing hospital-style 'black alerts' in GP practices, when patient safety could not be guaranteed.

The BMA's GP Committee published guidance proposing four 'operational pressures escalation levels' in March this year, however at the time NHS England said 'arbitrary caps on patient appointments would breach GPs’ contracts'.

Speaking in favour of the motion, Dr Mary McCarthy, a GP in Shrewsbury, said: 'It's not that I necessarily want them as a definite limit. What I want people to recognise is that seeing 25 patients a day is a reasonable amount of work to do. Seeing 50, 60, 70 patients a day, every day, year on year, is not safe. It's not safe for the doctor and it's not safe for the patient.

'I think this should be viewed like a speed limit - and I speak as someone with points on their licence - that there are occasions when you do break it. That there are obviously flu epidemics or a busy day, in which you do see more. But that you do recognise that you're working at an unsafe level.'

Speaking against the motion, Tower Hamlets LMC chair Dr Jackie Applebee said: 'General practice is in meltdown, we can't go on as we are, but what would a sensible cap be and how would we enforce it?

'Some suggest limiting consultations perhaps to 25 a day but how many of us would turn away our 26th patient when for example they're an 85-year-old who struggled to get down to the surgery. We are notoriously bad a saying no and no more so than to our registered patients.'

Dr Richard Vautrey, chair of the BMA's GP Committee, said: 'We have started working on this. We have produced a paper, describing how we can provide some safe limits for practices - how they can take control of that but clearly we need the investment as well to enable that to happen on a sustainable basis. But the way that this motion is phrased, we do believe you could accept it because it is helpful in terms of moving that agenda forward.'

Also at today's ARM, which is taking place in Brighton, a motion calling on the BMA 'to take urgent action to ensure the protection of "last man standing" GPs from any additional costs of resignation or retirement resulting from practice closure' was voted through unanimously.

In a speech introducing the GP section of the meeting, Dr Vautrey said: 'For far too long our service has been undervalued and taken for granted.

'GPs’ work ethic and dedication to their patients has been exploited through a decade of underfunding and soaring workload pressure, with the assumption that the GP practice will always be there to pick up the workload that others say they cannot or will not do.'

Pulse revealed last month that one in six GPs has already had to turn away patients for routine appointments due to unsustainable demand in the past year.

Motions in full

GWENT AND SOUTH POWYS DIVISION: That this meeting urges a sensible cap is agreed on the workload of a GP which can be expected to be safely delivered in a day for the safety of patients and sanity of GPs.

CONFERENCE OF LMCS: That this meeting is concerned about the number of recent practice closures and:-

i) believes that unmanaged dispersals lead to patient safety issues;

ii) believes that more needs to be done to make the public aware of the mounting threat to the system of general practice;

iii) demands details of the contractual arrangements to provide ongoing primary care after a practice closure, are made public;

iv) instructs the BMA to take urgent action to ensure the protection of ‘last man standing’ GPs from any additional costs of resignation or retirement resulting from practice closure.

Source: BMA

Readers' comments (25)

  • Pay per consult, either co payment or the current system, those that wanted to would see more,out of hour would be sorted and more importantly the government would have a vested interest in controlling demand.Easy for the BMA to implement renegotiate a contract away from the capitation payment to payment by activity.This issue would be sorted over night.As the BMA has shown they are pants at negotiating with the government on our behalf.I am awaiting workforce collapse as they settle for the status quo.

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  • Play the game.
    This is a marathon not a sprint.
    See the patients that you are contracturally obliged to see. Use catch ups/admin/supervision blocks (whatever you want to call them) to reduce patient contact.

    The more you see the more admin that produces-see less. The burden now is the admin-patients can be processed relatively painlessly. I send patients to A&E far more than I used to. I no longer refer to physio,counselling of chiropody--I "signpost" them to a private provider.

    The traditional GP service is on the brink of collapse-it will emerge in a different form.

    Life expectency is said to be 3 score years and 10---time for the NHS to die and for the GPocalypse

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  • 25 maybe 30 is prenty esp if you have lots of admin then 25 max. I hear some say that's not many and some are easy but I say fewer are easy and we are so used to cutting corners and switching off before the patient has finished and that's how we manage and say 25 meetings per day is not much. ive seen 60 per day regularly as partner with lots of admin and ive worked abroad where seeing 25 pt per day took me from 9AM to 8 pm with the paperwork and taking time with patients having breaks etc. quality not quantity

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  • Macaque

    @Penis McTaggart

    Exactly!

    When someone says 25 is too little reminds me of some senior GP dinosaurs I have worked with. They disregard evidence based practice, always give what the patient wants e.g.opiates, Benzos, pentins, lots of antibiotics so more patients would join the list, game the QOF. Make loads of money is the motto. I forgot, exploit all the other clinical and non clinical staff to their gain!

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  • These are not doctor leaders.
    They talk a lot at conferences but don't say anything or do anything.
    They talk about capping numbers and then retreat to their portfolio 3 sessions a week.
    They don't represent me.

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