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GPs buried under trusts' workload dump

Patients must be told safety is at risk due to GP workload

Editor’s blog

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Let me be frank: the general public doesn’t really care about GP burnout. The study showing 90% of GPs are at high risk, or tragic tales of GP suicide won’t make the national headlines.

It’s true workload in general practice is exceptional by any objective measure. Our cover feature shows GPs are working, on average, 11 hours a day. In how many other professions is that the norm – other than those where earning vast sums is the driving force?

Yet the general public – after years of misleading headlines about GP pay – will lump GPs in with the investment bankers and City lawyers. The only way to drive home the message that drastic change is needed is by emphasising the danger to patients.

Because there is real danger. Facing a daily conveyor belt of patients makes it impossible for GPs to give each the best care they can.

There are the more tangible effects, like missing an important point in test results, failing to contact a patient who is awaiting a call or rushing a consultation that needs more time because there is a waiting room full of other patients who need care.

But there are also the intangibles, maybe best summed up by our cover quote: ‘There is a point where I feel cognitively drained and, after about 20 patients, there is not an iota of sympathy left.’

Facing a daily conveyor belt of patients makes it hard to offer each the best care

I am in awe of those of you who can engage with, say, 70 patients in a day, treat the last one as you did the first and summon the empathy needed to give each one the care they need.

But this takes a superhuman. GPs should not be expected to work at this level and the profession now needs to deliver a stark message about the risks to patients.

It’s true the BMA and the RCGP have used patient safety as a message in the past. But the profession needs to connect on an emotional level and change the narrative. Those tales of burnout still need to be told, like Nabi nearly crashing her car after a 14-hour day, or Dr Rich Bennett, whose relentless workload meant a single patient complaint contributed to the depression that led to his suicide.

But we need to make the public ask themselves: if this is what GPs are doing to themselves, are they really able to give me the best care?

Then hammer home the demands: no new work introduced in the contract without equivalent work being removed, with a full impact analysis of the time saved (a boast of £20m being put into the global sum that boils down to 90p more per patient no longer cuts it); anything that even looks like screening having to receive approval from the National Screening Committee; and campaigns to inform patients when they actually should see a GP about self-limiting illness.

In addition, no new guidelines are to be issued before taking proper account of workload implications. This approach would even allow us to call for the abolition of CQC inspections, with the public told the huge workload burden they entail is harming, rather than protecting, patient safety.

There’s a chance warnings around safety will erode trust in GPs, which remains high. But, as workload grows and GP numbers shrink, the risk to patient safety will no longer be just a risk.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at editor@pulsetoday.co.uk

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Readers' comments (10)

  • National Hopeless Service

    Other than broken GPs nobody gives a toss about GP workload.

    This was top of Google Health News this morning.."Women are having lives cut short because GPs miss symptoms of ovarian cancer, study suggests"

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  • Jamie, your measures aren't enough, because you haven't delved deep enough.

    -no new work introduced in the contract without equivalent work being removed - That's simply stagnation, not improvement.

    -anything that even looks like screening having to receive approval from the National Screening Committee - Should have nothing to do with us and everything to do with Public Health

    -campaigns to inform patients when they actually should see a GP about self-limiting illness - we've had these for YEARS, and it accomplishes sweet F*ALL, due to the impression that seeing a GP is 'free'.

    -no new guidelines are to be issued before taking proper account of workload implications - Why should the state care when we are on a bulk contract?

    -call for the abolition of CQC inspections - will never happen when the state funds the sector. regulation follows the funding.

    The fundamental principle here is one of compulsion vs liberty/choice. Some people don't mind working more if they are remunerated for it, i.e. free market and choice. But compulsion makes people less likely to want to do what they are being compelled to do. The problem is the 'State', as it is unwilling to acknowledge the harm it is causing, or to consider the cure, which is relinquishing power. Fundamental change is required - voting for smaller state, minimal level state healthcare provision only, for GPs specifically - leaving the NHS(in its current state).


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  • It should not be down to a small but highly effective team at Pulse to deliver this message and survey The medical leadership at the RCGP and BMA GPC should have been all over it.

    One of the best pieces of writing and work I’ve seen in a long time. Time to hold those to account who continue to turn a blind eye to the problems practices face in their area. Each medical director should br surveyed to ask if they feel GP in their area is stretched beyond safe capacity - they have a probity responsibility to respond honestly, and a duty of candour to speak out where they feel patient safety is threatened.

    Hold the MDs to account who hold GMC registration - you will never get an honest answer from a manager who has no such regulatory responsibility,

    Time for a NHS managers regulatory body: they must be held to account for turning a blind left eye to the problems while having their right eye looking at the career ladder.

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  • |A Woodall | GP Partner/Principal|08 May 2019 1:00pm


    Time for a NHS managers regulatory body - Seriously, your suggestion is a regulator for the regulators? Then who's going to regulate them? and repeated ad infinitum? And you expect state bodies to be independent and objective? Whilst being funded by the state?

    Ask yourself - Why are the RCGP and BMA not 'all over it'? Because FEAR (of the consequences of not toeing the party line), and POWER, are strong influences. Hold all these people to account? Sure, how? By voting for smaller govt.

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  • TRUE, THE GENERAL PUBLIC COULDN'T CARE LESS ABOUT US AND WHY SHOULD THEY....THEY SIMPLY ASSUME THAT THE GOVERNMENT ARE ACTING RESPONSIBLY RATHER THAN LIKE NASTY SCHOOL BULLIES.
    TROUBLE WITH THIS APATHY IS THAT IT IS THE PUBLIC THAT WILL SUFFER...MUCH MORE THAN THEY DO NOW

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  • Jaimie All of this is pointless. We GPs accept a list based Contract. Consultations have almost trebled in 20 years. So, effectively a 1700 list was 3400 in 2000, is 10000 now.
    If LMC/ BMA conferences keep voting to keep the status quo, we can hardly blame the DOH or anyone else.
    If, on the other hand, we vote to provide a service based on appointments, it will soon be clear there are not enough appointments or GPs.
    But, year on year we keep list sizes. If consultation per patient rise every year, it is hardly the fault of someone else.
    I do understand that the major newspapers think we get paid millions for playing golf, so that is unlikely to change.
    Perhaps it will take a complete collapse of medical care for the BMA to act.
    Though, having done hundreds of 80 hour sleepless weekends and weeks of 1:1 cover in the past, I am not holding my breath.
    When the RCGP chair states 12 hour days and 100 contacts as a problem, but no solutions, we are in difficulty.

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  • Teachers,GPs,police and farmers all have a reputation of complaining about their lot in life. The public only become concerned when it effects them personally.

    We need to stop trying so hard to please everyone.

    Easy to say-hard to do.

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  • Lots of Guardian readers I know out there...anyone read what one of our own wrote today about wanting to "nationalise GPs"?

    https://www.google.co.uk/url?sa=t&source=web&rct=j&url=https://amp.theguardian.com/commentisfree/2019/may/08/gp-nationalise-surgeries-profit-patients-nhs&ved=2ahUKEwjygrTGoY7iAhUiHKYKHXRYDIoQyM8BMAB6BAgBEAQ&usg=AOvVaw2RpKJgL7DQKlH_AtBg5CFh&cf=1

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  • Lol Batman, I just read it and anyone with an iota of intelligence can see the holes in it.
    1. The author is a Labour MP
    2. He talks about NEEDS and Nye Bevan, when clearly Primary Care is no longer about just 'needs' anymore.
    3. He essentially suggests that GPs want to give up autonomy to be 'salaried' and wants bigger govt intervention, not smaller.

    Nah, fake news alert...

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  • Can I ask all the readers out there..... who do you think better represents our views...RCGP or Jaimie???? I have to say that I vote Jaimie.... he seems to be more in touch with the grassroots members and understands and articulates how the profession is feeling.....

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