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We need radical ideas to cut GP workload – but not a cap on list sizes

Editor’s blog

jaimie kaffash 2 duo 3x2

The latest suggestion that practices should be limited to 1,500 patients per full-time equivalent GP seems great in theory. Radical measures need to be brought in to tackle GP workload, and this is certainly a radical measure.

But the suggestion – to be debated at the Conference of England LMCs later this month – has obvious flaws. First – and most importantly - this will massively hit practice income.

Will GPs really be happy if their own union brings in a rule that will cut their funding? Who will police such a rule? Will NHS England look at their GP FTE numbers and cap their income?

Second, in the middle of a recruitment crisis, there are presumably a huge number of practices who exceed such a limit. Will they have to purge their lists, and how will they decide on the unlucky patients that are being thrown off with probably nowhere to go?

It is sad that asking GPs to ‘only’ work nine hour days may just be too radical

And how about those practices that have expended huge effort in adapting their skill mix to alleviate their recruitment problems. Will we tell them that no, that restructure that enabled them to stay afloat is no longer acceptable?

In my opinion, it is a non-starter. But I have sympathy with Shropshire LMC, which proposed the motion - presumably to start a conversation.

Because they are starting a conversation, and their other suggestion – that we cut the working hours to 8am to 6:00pm – may just work. But why stop there - how about a working day of 9am to 6pm? Sadly, it is an indictment of the perception of GPs that asking them to ‘only’ work nine hour days may just be too radical.

Jaimie Kaffash is editor Pulse. You can follow him on Twitter @jkaffash

 

 

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Readers' comments (7)

  • We need to make it easier for new GPs to open new practices. This should be part of the conversation. Not a panacea but important reform.

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  • can they cancel my appraisal for starters?
    Pleeeeese.

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  • GPs study medicine in order to become competent physicians able to diagnose, treat and support their patients from the effect of said conditions on their physical, emotional and social status.
    Their role should NOT be to manage social crises, minor mood disturbance consequent to living conditions or their work environment or patients social inadequacies unless there is a significant underlying medical condition.
    GPs should remain gatekeepers for the NHS as their role is invaluable to ensure resources are used appropriately.
    Over the course of my 35 year career in Primary care, I have seen GPs assume the role of social workers to the detriment of having sufficient time to get stuck into diagnosing real pathology or taking time to help their less capable patients manage recurrent minor illness. Consequently, referral rates to secondary care have gone up and the GP role has been downgraded to following pathways through guidelines and supporting the less adequate. Many GPs now seem to assume this lesser role and even defend its importance.
    Surely, we do not need highly trained medical professionals to fulfil this role. We should have a team to whom we can offload minor mood disturbance or housing or employment issues and resume the role for which we were trained. -I am sure their hourly pay rate would be considerably less than ours and they would not need to spend 5 years in medical school and several years in junior hospital grades to perform these time-consuming duties.

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  • How about practicing evidence based medicine rather than seems a good idea medicine? That would get rid of most of our preventative medicine by which I mean medicating mild to moderate hypertension, most prescription of statins (keep the secondary prevention in middle aged men), most asthma clinics (the patients vote with their feet on this anyway), most copd clinics (ditto) and most work to do with ckd. Also how about stopping the continued testing for microalbuminuria in diabetics after the diagnosis is confirmed? It adds nothing. Some guidelines I suspect are not evidence based - the new breed of gps is so terrified of sanction that a patient with a haemoglobin 1 below the lower limit of normal is sentenced to a 'spit roast' endoscopy.

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  • Ronald Wilkinson

    Radical indeed
    10-15 min appt very stressful for GP, ANP, Para and most importantly the patients we are trying to treat. Often the Patient has not had a full set obs for years ..
    I feel would be far more reassuring and cost effective long term if any patient presenting with new condition could have full set obs at appt , this would empower and give a bench mark about where they are today with their self care and whet would be needed to improve.
    Yes the GP, ANP and Paramedic would not see as many patients but with a more empowered patient community would reduce demand longterm...therefor freeing up valuable appts?

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  • Ultimately, there is only so much intense work any person can do without rest or break. That work needs definition. This is difficult. I did maths originally and I see the Universe as a function of numbers. Even care and compassion needs personnel [ numbers] and time [ numbers], quite apart from the human side.
    So, list sizes are not an answer because consultation rates are increasing, such that a list size of 1500 in 1948 is equivalent to 10000 today in consultations.
    Consultation or timed appointment based systems would be fairer to all. I spoke to manager today who felt that all GPs do,is refer onwards and really their workloads are not heavy.
    We can in a new Contract provide a certain number of appointments a year for a certain fee.

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  • The NHS/country only wants to pay for a micro-managed,scaled down, dumbed down, corner-cutting, difficult to access, version of general practice. Some practices are better than others at working through the resulting business challenges and manage to keep F/T partner profits at 120K+. Others due to being 'too caring' or unlucky demographics earn much less than this and for some their hourly rate is only slightly more than that of the new breed of high powered pharmacists we are being encouraged to employ.
    The Government and BMA don't care about this so enjoy the variety of pathology you see and your income and pension and be careful not to retire too knackered to enjoy it.

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