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At the heart of general practice since 1960

No rest for the wicked GP

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I find myself conflicted. It doesn’t happen that often as my husband will confirm. But I am wrestling with myself over a perplexing situation. Not a patient with tricky diagnosis, or an ethical dilemma. No, it’s tea breaks. Or more precisely the RCGP’s latest campaign, which compares GPs with pilots and HGV drivers in highlighting that fatigue affects safety. I’ve watched the reaction online with interest, and largely resisted commenting, mainly so I don’t get any patronising responses from ardent fans of the college, but also because – well – I kind of like it.

I firmly believe practices where GPs make a determined effort to take a break to share a quick brew are happier places to work

Don’t die of shock just yet. There are caveats. I firmly believe practices where GPs make a determined effort to take a break to share a quick brew are happier places to work. When I’m locuming, I can tell within the first 10 minutes whether the practice is the type of place that has a tea break, or a place where doors shut and don’t reopen for the duration. I suspect many of us used to meet over the visit book, chat/complain about the morning’s surgery, exchange a few pleasantries. But with the advent of IT systems meaning visit books are long gone, and the fact there’s barely time to eat or pee, let alone have a leisurely cuppa, it’s a lost art.

So it was I found myself nodding in agreement at the thinking behind the college’s latest posters. It is unsafe to work when overtired. We are firefighting and lurching from one near-miss to the next, just waiting for that complaint or missed diagnosis that will catapult us to the GMC.

But here’s the rub. The campaign does have a valid point, but it misses the crux of the matter. You can’t compare NHS primary care, with its all-you-can-eat approach to healthcare, with a safety-oriented and heavily fatigue-aware industry like aviation. Pilots will not fly without adequate rest. They are not criticised for this; indeed the RAF has serious penalties for staff who fail to take their scheduled rest breaks due to overwhelming evidence of negative outcomes for fatigue. For GPs, though, fatigue, illness and personal issues are traditionally shoved under the carpet. Working part time is just about acceptable, but no one really wants to work with a colleague who won’t soldier on through any illness that doesn’t involve the forceful ejection of bodily contents. Arguably that was why Imodium and Stemetil were invented anyway.

Also, our ‘customers’ as patients now seem to be called – and I’d lump politicians in there too – have little time or sympathy for our plight, given their tabloid-skewed perception of what we do. And once again it feels like it’s our fault. Your GP will make mistakes if they are tired. If they cock it up and kill you it’s down to their failure to take breaks. Maybe I’m oversensitive. But I’d love to see a campaign with a tag line like ‘General practice collapse imminent – who will treat your family?’, or ‘NHS failing – can you afford to go private?’

For all its good intentions, this campaign feels like another shot in the wrong direction. Maybe the college can learn from the RCOG’s fiery message to the Government over the junior doctors’ strike, and clearly show whose side it’s on. Let’s discuss it over a cuppa.

Dr Zoe Norris is a GP in Hull

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Readers' comments (11)

  • Tea breaks don't address the workload though.

    A 15m tea break in the morning may well translate into staying 15m later in the evening.

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  • Great article

    Isn't this precisely a cultural problem though? We should be super-safety conscious. We should have scientific data about error rates and risk. We should have clear boundaries on safety and contact-volume. But we don't.

    I agree that this is the wrong way to approach it, but the comparison is helpful because we should be EVEN MORE careful than truck, train and plane drivers. Time we held HMG to account on it - like the suggested headlines for RCGP though - MAUREEN TAKE NOTE.

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  • Link to the RCOG comment here

    https://www.rcog.org.uk/en/news/rcog-statement-on-new-contract-proposals-for-junior-doctors/

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  • 113 year ago the Wright Brothers flew the world's first airplane.

    To compare medicine to flying is to ignore the fact that the medical profession is like trying to keep a Wright brothers era plane running, whilst also keeping WW2 and 1960s planes in the air, with funding equivalent to production lines rather than bespoke engineering, an absence of fuel, and members of the the legal, press and political corps watching your every move with a clipboard and criticism in case you do something wrong.

    Oh and the plane is still flying whilst you are on the wing trying to fix it.

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  • We always try to meet every day - for support and friendship. It is worth a huge amount and despite the IT, we still keep the visit book!

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  • Hmm and airlines have aircrew on standby to come in when a colleague calls in ill - so that's 20000 new GP we need by 2020 then :. Some will also encourage them to remain off work until they are certain they are 100% fit - not necessarily for flight safety reasons, but to avoid the hassle and disruption of last minute rota changes - if only

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  • My oractice has a coffee break in the morning, which we all try and attend, even if it means patients waiting. It does make the day even longer, but the reduction in stress and opportunity to talk to colleagues is worth this.
    The REAL issue is our workload. The BMA,RCGP ,NHSE need to address this urgently. There is obviously a huge amount of health anxiety in the population which is generating uneeded tests and GP time. Overall i think this is likely to make patients health worse. It is nearly impossible for GPS not to investigate somatic symtoms as if they do miss the needle in the haystack they could be sued/struck off. Somehow we need to get patients to understand that they need to exercise restraint/address their anxiety. Maybe charging for tests or GP appointments or limiting amount of appointments. I dont know .I do know the status quo cannot continue , as the length of the day is unsafe for patients and consequently patients.

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  • Take early retirement and have all the extended breaks you want

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  • Everyone talks about excessive workloads [ including Maureen, who does not wish to be the 50th patient of the day], but no one can say what that means. What number in a mathematical world should we not see, how many hours should we not work? You cannot work 5000 hours continuously, so what is the number?
    And how can we incorporate that into a John Wayne Contract ?
    That is why everyone is leaving, the workload is unsustainable.
    As Prof Nicholson put it, we should have resilience training like frontline soldiers [ who, thankfully do get a break after some months]. So there you have it, GP land is like going to war without a break.
    The Contract has to change from a patient based to an appointment based or item based one.
    If we continue in this fashion, there will be no GPs left as workloads escalate to impossible levels for everyone.
    We have to define safety like pilots or lorry drivers.
    Having done hundreds of 80 hour weekends on 3-4 hours sleep, it amazes me a] that my Union allows me to work hours slaves did not and b] that we doctors of all people think our physiology somehow superior to a lorry driver.

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  • Why is the Health and Safety Department not interested in NHS patients treated by GPs and why are they not investigating GP mistakes? Probably because GP activity is not considered industrial!! We are independent contractors, so no Health and Safety for us! As independent contra tractors we have no protection of any sort, not even our human rights are protected. The Dept. of Health doesn't want to know. Coroners do not want to know. What a state of Nirvana. Only the dragon GMC can wake us from our slumbers!! How untouchable we are (pun intended)!

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