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Clock off at 7pm? If only

Dr Farah Jameel calls for a UK-wide survey of GP workload

After hearing Jeremy Hunt’s message that GPs need to stop clocking off at 7pm, a number of GPs tweeted about the reality of their working day:

‘In at 8am, out at 20.00pm, stuff left undone…’

‘Clocked off at 9.45pm yesterday after an 8am start’

‘GP mother, came home at 10pm last night. Was in at 7am #thenorm’

‘First patient 07.30am; logged out of computer 11:30pm. Selfishly took an hour and half off at 7pm to go home, no lunch tho’

The Northern Ireland GP workload survey is the most up to date comprehensive study we have on GP workload. It takes into account complexity of general practice and has recorded activity outside of consultations. It covers an 11-year period from 2003-2014. The data shows that the number of test results dealt with by practices increased by 217% in a decade and administrative tasks by 115%. It also shows that the average GP carries out 47 consultations, signs 172 prescriptions and files 35 lab results per day, equating to a minimum of 11.3 hours every day. And the work doesn’t stop there.

We keep saying we’re working flat out - having 60 contacts a day or more - but we still haven’t yet undertaken a UK-wide piece of work that could help us identify where and when we may need to draw the line. Nor have we asked when GPs being this overworked might begin to affect patient safety. This does us adisservice. Supportive, sympathetic organisations such as The Kings Fund, The Nuffield Trust, and the DDRB recognise we’re working flat out, but there’s simply no definitive evidence that could help us work out how to bring about positive change.

The last UK-wide workload survey was carried out in 2007 and only really looked at patient consultations; it did not reflect the complexities nor record additional activity. Any current day data presented on workload is simply based on an extrapolation from this old data. The 2007 survey recorded that full time GP Partners (full time being regarded as those who worked 8 or more sessions per week) worked on average 44.4 hours. What’s also interesting is that QOF had only just been introduced in 2004 and other bureaucratic measures followed much later. This survey is clearly well out of date. 

Two out of three GPs are facing significant work related stress, nine out of 10 GPs state that workload pressures are damaging quality of patient care. And this is reflected in our workforce, with ever increasing difficulties being faced in recruitment and retention.

What we need now is to build on the great work done by Northern Ireland GPC. We must conduct a workload survey across the UK in collaboration with other stakeholders to help us define what’s safe and what’s sustainable in general practice. Only then can we put in place structures to support and rebuild the profession. 

Dr Farah Jameel is a GP in London and a member of the GPC

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Readers' comments (16)

  • Good article. Remind me not to work as a locum where you're working. I was at work 7.30am to 9pm every day when I worked AS A partner and did at least 4 hours remote working at weekends. I left that job few weeks back. Such freedom you wouldn't believe until you do it.....

    Large parts of our work have been "un-doable" for some time, we are simply deluding ourselves, soldiering on not shouting out !. Do we not have responsibility to alert NHS England, GMC, CQC, Medical Directors when we are being obstructed in overcoming organisational barriers to good medical practice? Impossible situation at times.

    Dr Margaret McCartney states quite rightly "GPs cannot safely see 40 or 50 patients a day, with two or three problems each, and not slip up. If the GMC can’t recognise this, we need a regulator that can." I know that needed saying but what difference will it make?

    There does come a point when you're working crazy long hours when you ask yourself why do it? If you cannot afford to give up work, that's partly the answer but I would would say we work excessively to mitigate risks of mistakes, falling foul of the CQC, GMC, litigators and ombudsman etc. In otherwords we are working above and beyond the call of duty out of FEAR.

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  • Farah Jameel

    It has to be said, I don't actually work till midnight! That is the caption the editor chose for the article, based on the working lives of many partners.

    I do routinely work extended hour clinics till 8 and 9pm at some surgeries though.

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  • Our mistake, we have changed the headline.

  • If this gets out then no one will want to do general practice. It might even cause a recruitment crisis.

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  • Pulse supports GPs well, and I thank them for that, but they have to be careful of hyperbole.
    The facts speak clearly for themselves on these issues and the current constant workload norm is far more shocking than the occassional exceptions.

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  • The inevitable collapse should be allowed to happen sooner. Then things will improve .

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  • Azeem Majeed

    The NHS in England does not collect or publish statistics on GP workload. Our capitation-based contract means that GPs are (by and large) paid a fixed amount for the work they do. Many GPs are complaining that their workloads have become unsustainable and unsafe. Without some accurate statistics, it's hard to measure by how much GP workload has increased in recent years.

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  • Just measure the numbers of GPs leaving. That tells you all you need to know. After all we have to be pretty desperate to throw in the towel.

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  • A lot of this smacks of a 'hair shirt mentality'
    If you are working this hard, then arguably you are not managing your workload efficiently. You could also
    take a pay reduction by reducing your sessions, increased use of locums, take on a salaried for fixed sessions( and pay them properly!)etc etc.
    What price sanity and achieving a manageable work/ life balance?

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  • Well if sessions were reduced in line with the increase in intensity and workload GPs would probably be looking at a 50% real terms pay cut over the past decade.
    So it isn't a 'hair shirt mentality', it's highly skilled professionals trying to maintain an income and some kind or work/life balance without selling up everything they have worked for and moving into social housing.
    Because if that is the only option, there are many who will and have chosen locum, emigrate, retire.

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  • Glad I moved to Canada. Now every item of work I do is appropriately recompensed. I feel BMA and doctors are missing a golden opportunity - say yes to working 7 days a week so far GPs and consultants are allowed to bill for each item of work. The only reason they are asking GPs to do more is because they know they won't have to pay for it. They want the service for free.

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