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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)

  • Vinci Ho

    I suggest those representing us to study carefully and ‘digest‘ the ‘working time directive’ or ‘working time regulations’ before proposing any actions:

    weekly working hours

    Contents

    Government Digital Service
    You can’t work more than 48 hours a week on average - normally averaged over 17 weeks. This law is sometimes called the ‘working time directive’ or ‘working time regulations’.

    You can choose to work more by opting out of the 48-hour week.

    If you’re under 18, you can’t work more than 8 hours a day or 40 hours a week.

    Exceptions

    You may have to work more than 48 hours a week on average if you work in a job:

    where 24-hour staffing is required
    in the armed forces, emergency services or police
    in security and surveillance
    as a domestic servant in a private household
    as a seafarer, sea-fisherman or worker on vessels on inland waterways
    where working time is not measured and you’re in control, eg you’re a managing executive with control over your decisions

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  • Unfortunately Dr Applebee's attitude is, in my opinion, wrong. Just because there is a problem with excessive demand it doesnt mean GP's should pick up the slack for no extra money.

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  • All words and no action. This is never going to happen as long as useless BMA, HSL and old represent grass root GP.

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  • Impossible - the whole reason General Practice still exists is that it is an unlimited amount of work for a fixed amount of money.

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  • Well said everyone. The dedication of the doctors have been exploited for years through moral grounds and guilt. Work, number of appointments and time has to be linked to pay. There is only 24h in a day and we are only human. Block contracts are used to exploit us and make us see unlimited patients and unlimited paper work, prescriptions, blood tests and taking on unnecessary risks like child protection. If anyone want to take on more work for free please put your contact details on. I will contact you as I have plenty of jobs for you as do all my colleagues.

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  • Vinci Ho. The controls started as the European Directive on Certain Aspects of the Organisation of Working Time. This evolved into the European Working Time Directive in 2003 (2003/88/EC). The latter was incorporated into UK law by the Working Time Regulations 2003. However this only applies to employees so does not apply to partners and locums (and anyone who is self directive of their working hours). The maximum of 48 hours (average over a 17 week period) can be legally opted out of by an employee (ie cannot be enforced). As usual there are exceptions, which until 2003 included Doctors in Training.

    Just wanted to say as one of your representatives, that this is well known and understood … ;-)

    However, the problem is often not so much with the total number of hours worked, but the intensity of work within those hours

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  • This could be useful in several respects eg. Evidence when trying to close list, defence when being chased by gmc/coroner etc.

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  • What Now?

    Insanity: doing the same thing over and over again and expecting different results.
    Read more at: https://www.brainyquote.com/quotes/unknown_133991

    We are going insane
    something has to change

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  • Fine words , but how can it be introduced (and how quickly)
    If a GP sees more than their limit will they be paid more or fined for breaking the cap?

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  • 25 a day is unreasonably low. Let's be honest - not all our consultations are long and complicated, and they are balanced out by the 'quickies'. We must not turn away ill patients just because our quota for the day is full - that is morally indefensible. There are many other ways of reducing workload which I would readily support e.g. scrapping unnecessary bureaucracy.

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