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Three simple solutions to the workload crisis

Dr Zoe Norris

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It’s summer. The sun is shining and the birds are singing. And something has happened that hasn’t for years – since 2010 by my reckoning.

There is a funny coloured appointment slot on my screen. It doesn’t have anyone’s name in it. Clearly there’s been a computer glitch or an IT meltdown.

I see some patients, but it’s still there. The mysterious slot – it looks like I am seeing someone called ‘Book on day’.

There are never ever unbooked appointments in my day. In fact, it’s something I reminisce about when teaching students. ‘I remember the good old days back in ‘07 when there were three or four gaps in each surgery, when Choose and Book didn’t exist, and when the district nurses and health visitor were in the same building.’

It was only one empty appointment but it felt like the pressure valve had been opened

They look at me like I’m losing the plot in my middle age. But there it was just this week. An empty, unbooked appointment slot. The next day brought another – just the one mind. It didn’t make up for the fact I was still busy, although it did mean I was only 20 minutes late rather than 30.

But it made me feel awesome. It was only one slot but it felt like the pressure valve had been opened a fraction, and I had space to breathe.

There’s been lots of talk about the GP partnership review that is being chaired by Nigel Watson. Everyone in the corridors of power wants to hear the magic fix to improve GP recruitment and retention – how do we get more partners? How do we make everyone stop locuming, damned work-shy individuals that they are?

Well here you go. If a single unbooked appointment can lift my mood that much and make my day feel so much better, general practice really doesn’t need new jazzy schemes to help it. It needs a little tiny unbooked appointment across the whole system. Let’s not reinvent the wheel.

The solutions are obvious – but it seems everyone wants to avoid them.

First, every GP needs time away from the front line, so fund a national weekly half-day closure. Give every practice an afternoon off. Pay for out-of-hours cover out of a national pot. Money well spent.

Second, set a maximum number of patients that can be seen each day. Stop letting the hand wringers get in the way of common sense. Place a limit and tell the profession and the public. There are safe staffing levels in hospitals, why not in general practice?

And third, give each practice 30 days of free backfill. They can use it as they wish – holiday cover, sickness absence, business meetings. Whatever. But every practice gets 30 days of cover, paid for centrally. They get the space they need.

Yes, this needs a funding boost. But, let’s face it, the reason the 2004 contract improved recruitment wasn’t because everyone was so excited about the QOF.

I’ve come up with three solutions in the time it’s taken me to write this. None is impossible or far-fetched, and each would make an immediate difference to every practice.

Why is this so hard? And why isn’t anyone listening to us?

Dr Zoe Norris is a GP in Hull 

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Readers' comments (10)

  • Hi Zoe

    While I like the sound of your proposed solutions, it's pretty clear why policymakers haven't rushed to implement them:

    Suggestions 1 & 2 obviously reduce GP availability and ability of patients to get a GP appointment.

    Suggestion 3 also reduces GP availability unless there are locums in the UK looking to work 225,000 extra days annually. (30 days x 7500 practices).

    I'm not saying your ideas are impossible, I'm not saying I have a better plan. But your plan is essentially: see fewer patients. Maybe it's the right plan but don't expect policymakers to leap at it.

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  • Underfunded health systems in third world countries utilise bare foot clinicians to make certain that only the very ‘ill’ are seen by Doctors. Little chronic disease management takes place. Of course here in the UK society may not accept this, but because of the overwork clinicians are walking away from health care in their droves. Doing nothing will sooner or later lead to the implosion of the NHS. What will our Politicians do then?

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  • It will never happen..... the private clinics must flourish, the NHS must suffer to drive patients there.... look at where all our glorious health ministers end up.

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  • Sensible, practical, well thought out...

    ....and therefore not a hope of ever being implemented.

    Lions led by donkeys.

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  • Good ideas will never be considered, keep slaying us until no one is left, then let’s worry about patient access. Why are GPs so desperate to work themselves into an early grave to keep the punters happy? They will still want more, still complain they don’t get what they want, they still blame us for secondary care failings and still feel we’re not real Drs. About time we looked after ourselves and realise this is just a job not a prison sentence and certainly not a vocation.

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  • One simple solution to workload crisis - a £10 charge for every appointment.

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  • “One simple solution to workload crisis - a £10 charge for every appointment. “

    Here’s the real solution but alas the cardigans have voted against it.

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  • Many of our GP colleagues already only work 3 days a week, so why is Dr ZN wanting another Half Day off: sounds a bit lazy and greedy, and see even fewer patients, and even less continuity of care, and even more patients having to attend A and E instead. Also, she wants "backfill": what's that about, except to do less work again without harming her pay?
    Get real. This was once a profession where dedication and devotion to our patients meant something. It was a vocation where you put your patients as your top priority. Not "Me,me,me"!
    Also, we should not be calling for charges for patients to see a GP: which sounds like doing some nasty job on behalf of the government.
    We should be defending our patients, many of whom are already feeling unnecessarily guilty when they book an appointment, from charges to see a GP. An NHS that's Free at the point of access: we don't want a Fake NHS with more restrictions: we have more than enough restrictions placed on patients and GPs already.
    As for "cardigans": they often know a lot more than than self-deluding young whippersnappers who are still "wet behind the ears"...

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  • None of these ideas increases the supply of gp hours.
    To do that we need to make GP more attractive to young doctors, and abolish the absurd rule that makes the UK the only country that does not allow qualified doctors without the MRCGP to work under supervision in General Practice. Come on RCGP BMA etc

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  • Why’s no one listening you ask? Because in order to become a top politician you have to be born with congenital deafness.
    And to those that disagree just prove me wrong.

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