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GPs go forth

Pulse 2019 review: GP workload laid bare

Pulse’s major workload survey found GPs were working beyond safe limits. Allie Anderson reports

It’s not news that GPs are stretched. But the extent to which their excessive workloads impact their own mental health and patient safety was unveiled this year, in Pulse’s first ever workload survey.

The survey was conducted over a single day – Monday 11 February – in an attempt to get a snapshot of what the typical working day is like for GPs.

Nearly 1,700 GPs took part either by submitting responses online, or by sharing their day on social media. They described the unyielding pressures they face daily, revealing that many feel they are working in unsafe conditions.

On average, GPs work 11-hour days, eight of which are spent delivering clinical care. They think a safe limit of patient contacts per day is 30, yet in reality, the average is 40.

The picture was accurately summed up by some GPs who got in touch with stories from their overworked colleagues who were too busy to respond themselves.

Despite estimating a safe daily limit of patient contacts as 30, as many as 10% of respondents reported having double that on that February day, which they said was typical.

Survey respondents said they’d had a mix of face-to-face, phone and online consultations and reported that one-third (33%) of cases were either ‘very complex’ or ‘fairly complex’.

More alarming than the statistics was the deluge of anecdotes, many of which are nothing short of heart-breaking.

‘There is a point where I feel cognitively drained; after about 20 patients, there is not an iota of empathy left,’ said one Hertfordshire GP, who described feeling ‘mentally and physically exhausted and more likely to give in to patients’ demands’.

This pressure not only shakes one’s confidence in patient care, the GP said, but ‘affects your home life too’.

Another GP said the risk to patients escalated throughout the busy day and that, by lunchtime, he ‘felt on the edge and risked missing urgent tasks… thus affecting patient safety’.

The causes of growing workloads are widely known. Too few GPs, practice closures and increasing patient demand create a strain. Hairbrained government plans – like advising patients to see their GP if they don’t know their blood pressure – add to it.

The incumbent health secretary Matt Hancock later promised to field some of the additional appointments this would inevitably generate with 6,000 new GPs by 2024-25.

If that doesn’t spread the workload, GPs could follow the example of their Spanish peers, who took to the streets of Catalonia in a week-long protest at their high patient numbers and unfavourable working conditions.

One thing’s for certain: the status quo is unsustainable. One GP sadly paid the ultimate price for being stretched beyond his limit this year – and that’s one too many.

Readers' comments (8)

  • GPs and the public had a "contract"....the unwritten rule was that we cared for them and in turn they cared about us.
    But things have clearly changed.....not universally but, in general, they could not care less whether we are sad or happy, burnt out or not or indeed dead or alive...other than being dead means a clinic cancelled potentially at short notice.
    The contract is now broken.
    In response, many younger GPs cannot see why they should still fulfill their part of this historic deal which is "giving their today for someone else's tomorrow".
    Would you surrender your entire life for someone who could not give a fig about you.....?
    This summarises the problem......and this is the new reality and there is no going back now.
    Without this deal, General Practice is just a job and therefore subject to scrutiny like all other jobs in that if the terms and conditions are crap, then nobody will do the job.
    The Government benefitted hugely from the "historic contract" and it is they that threw it away. In turn it is they and sadly the general public that will suffer from this terrible blunder.

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  • I see that Simon Stephens has got his knighthood.

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  • Vinci Ho

    Yes , we are indeed talking about certain ‘social contract’ in any western democratic system fundamentally.However , we have seen substantial erosion of this virtue globally in the last 3-4 years and has become ubiquitous , boiling from the top to bottom levels . Terms and conditions could be set with ambiguity and easily distorted or ‘broken’ later on . The latest PCN service specifications will be a potential battleground of confrontation between us and the government.
    The passing of the motion about GP home visits in national LMC is another tip of the iceberg . As I wrote before , our fight is no longer about our moral compass( alethiometer if you are a fan of His Dark Materials!) which was inevitably taken for granted by the politicians(some may say the public as well but I would reserve the blame for the government setting another social contract with people) .
    The result of the general election had certainly reinforced the stronghold of the PM and its government but not without any serious prices; everyone is simply watching him to make the first ‘mistake’ . And if I ever was a conspiracy theorist , the calamity two days ago (Friday evening) of publishing the 1000 addresses of New Year Honours recipients( with a few very controversial candidates) online in ‘error’ ( not sure Simon Stevens’s was on that list?) , could be easily a deliberate leak.
    For those who are representing us , GP, it is all down to fearless bargaining with the government for these terms and conditions. Our weapon is this retention and recruitment crisis . There is no place for political naivety and insensitivity any more .
    I know many would have given up hope taking an early exit while others might still think they could carry on living in a bubble of protection , the reality should be somewhere in between .
    I ask myself whether I should carry on after 25 years every single day, and taking up this position of a CD of a PCN could be the most imbecile thing I have ever done in my life but perhaps , it is really not about deserve , it is about what I stupidly still believe.............
    Mr Putin might suggest western democracy is ‘dying’ and Mr Xi might want to advertise his own socialism with Chinese characteristics as a replacement, I beg to differ by suggesting western democracy, on the contrary , is undergoing an evolution under 21st century technology..........

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  • Vinci Ho

    Why 2020 will be a crucial year for the NHS?
    Nick Triggle
    Health correspondent BBC Health
    https://www.bbc.co.uk/news/health-50852120

    If you look at the number of obstacles the PM is up against in NHS , he clearly needs us(GP) more than we need him .....

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  • I agree with Last Man Standing, please keep caps lock off it makes your posts so much better. When they changed the pensions that was massive. Used to get to lunchtime and wonder about how to carry on. You can't wait to live your life once you've retired.

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  • The government is simply not willing to pay enough for primary care to be delivered by GPs.

    For our own sanity, we must deliver the service that we are paid to deliver, which will mean using cheaper, more diversified workforces.

    If the consequence of this is a worsening of safety and delayed diagnoses in some cases, then that sadly that is the service that has been commissioned. If the public want better then they will just have to vote for it.

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  • Apparently only 40% of GPs favour introducing fees and charges for all NHS services. So we are shooting ourselves in the foot. Sixty percent of GPs are thus too left wing (Socialist).

    I personally favour a fee of £20 for every GP appointment and hospital appointment ; - send people a bill in the post after the service has been given so that it is still "free at the front door".

    This would help control demand for the NHS. This is a bad model - we should adopt the model of France or Germany. I think the US model is too expensive and profiteering.

    We all need to go and see our newly elected Right wing Conservative MPs and ask them to change the NHS model.

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  • Medical School: Problem based learning = Pay us and teach yourself

    Foundation Training: Dear F1 please provide cover to every single ward in this hospital on your own. Dear F2 please provide cover to this Medical High Dependency Unit despite you having none of the competencies relevant to safely run it and could you also review referral to medical HDU from other wards please. (at-least that was my life in Kent)

    Speciality Training: All the comments on Pulse reflect the views/attitudes of other specialities not just general practice

    Conclusion:
    We've all been groomed to be socialist doctors who work more for less in return so Dr Hossain the 60% statistic is not at all surprising to me.

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