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GPs cut work commitments to cope with rising workload and stress

Exclusive GPs are taking drastic action to reduce their stress levels, with many cutting the numbers of sessions they are doing, changing practices or quitting general practice altogether, say medical accountants.

Two months into the new financial year, accountants say GP partners are looking at various ways to manage their workload including reduce the number of sessions they work, changing practices or retiring. LMCs are also advising GPs to reduce their work commitments.

The comments show the beginnings of the workforce crisis predicted by the GPC and LMCs as a consequence of the hike in workload due to the contract changes that came into force from April. A debate at the recent LMCs conference last week revealed there has been a five-fold increase in the number of GPs seeking occupational health support owing to stress since 2000, many of whom go on to take retirement.

As well as the 4% pay cut predicted for GPs this year, Bob Senior, chair of the Association of Independent Specialist Medical Accountants and head of medical services at RSM Tenon, told Pulse many GPs have reacted to increased work pressures by moving from nine to eight weekly sessions, but were putting themselves under even more pressure because they are trying to fit a full time job into four days.

He said: ‘GPs are noticing the stress there’s no doubt, but whether the solution is to try to do [the job] in a shorter week and have a day off is questionable.

‘For many it is counterproductive. Those eight sessions are really long, ugly sessions. Twelve-hour days are common and, hardly surprisingly, on the fifth day they’re feeling absolutely shattered.’

He added: ‘The challenge is decreasing the workload. You might technically take some of the face to face appointments out of the equation, but that doesn’t have a direct effect on all the administration and peripheral work.’

He estimated that over half of practices now regard eight clinical sessions as the norm, although this was now becoming unsustainable due to increasing workload.

Michael Ogilvie, client service director at OBC Accountants, confirmed there was ‘definitely’ evidence of GPs working fewer sessions, with the recent changes to pensions partly to blame.

He said: ‘Especially when GPs´ profits fall into the £19,000 60% tax window above £100,000. They receive so little of the money after superannuation they would often prefer to be without it.

‘Many GPs over the age of 55 are actively considering retirement and possibly returning as partners or even locums without the superannuation cost attached.’

He advised GPs to look at sharing costs with other surgeries and even outsourcing some work to allow them to spend savings and help reduce their burden.

Ann-Marie Tulloch, partner at Dodd and Co accountants, told Pulse she had identified a big rise in GPs quitting the profession or moving practices this year.

She said: ‘Partners are either changing practices or genuinely retiring and in other cases they are leaving for workload reasons, to become locums. Others are leaving to work on clinical commissioning groups.’

Dr Michelle Drage, chief executive of Londonwide LMCs, told Pulse that they were advising GPs to review their work committments in order to reduce stress.

She said: ‘There are a limited ways of managing it but one of the key ones is to look at your workload and what you can personally remove from it – and that may involve removing you from it.’

‘We don’t have enough resourcing in practices anymore to buy in solutions. Previously we might have brought in a locum or sessional GP but those things are now unaffordable.

‘There is no money in the system or desire, which is even more worrying, to support it. So doctors are in a pressure cooker situation at the moment.’

Pulse revealed this week that six out of ten GPs would consider resigning if the Government goes ahead with its plans to force GPs to take back out-of-hours responsibility.

Readers' comments (25)

  • The free market starts to have an effect.Suck it up DOH

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  • The DoH may be surprised to know that GPs, while prepared to sacrifice their personal health and family lives to a large extent, are actually rational human beings.
    I would question those who do not cut down. Are they unaffected by the stress ( uncaring, insensitive personalities), lacking in any other priorities in life ( and maybe at higher risk of using alcohol and drugs to cope) or simply lacking the insight into their own needs?
    Sadly the people who will leave are more likely to be the more caring and giving who have become burnt out and the patients will detect the loss.

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  • I think most would agree that it is time, whilst understanding the needs of patients, to also look after ourselves. Unlike previously it is a different professional mix, with a higher proportion of women and part-time workers (not a bad thing, just a statement of fact) and we no longer half 'the other half' at home to answer the phone in the middle of the night and work as a free secretary.

    The public and DOH should get the service that they are paying for - and at the moment they're paying around £80-100 per year. That would not go very far privately and we need to deliver a service according to how much they are willing to spend.

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  • What a perculiar society we live.

    GPs, as a group, are a innately caring altruistic group. These qualities are no doubt nutured by a sense of worth. It is likely that many have good skills to prevent and manage stress. All of this keeps them working in a productive manner.

    I'm no business guru but it's obvious that skilled professions cannot be managed in the same way as unskilled jobs.

    Work output is reliant on the workforce.
    To maximise work output of a "packing" production line that requires no skill and only 5 minutes training the worker should be worked at 110% with the knowledge that they will become ineffective quickly. The manager then replaces them with the 100 or so people lining up to take on the role.
    This model however does not work in skilled professions........the reasons are clear.

    Aside from this, working a skilled professional at high intensity will lead to a drop in productivity - acutely there will be poorer decision making. Chronically there will be mounting stress. In the field of GP this leads to inability to remain educationally up to date, potential for worsening interpersonal skills, increased sickness, burnout, lack of business planning and development etc etc etc.

    The governments way of interacting with GPs seems very perverse. The desired outcome - I would think - is to have an enthusiatic, responsive, autonomous medical workforce that is able to use resources to achieve the best outcomes. The governments actions seem to be doing everything they can to prevent the desired outcome by demotivating GPs and encouraging distraction from the tasks that would lead to improved outcomes. It really is a mind boggler. It's not rocket science that undermining people leads to reduced output. What are these intelligent educated politicians up to?

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  • Anyone with an ounce of common sense could see this coming at least 2 years ago. The politicians did not. Do they share a common sense deficiency syndrome or are they simply so far removed from normal society that they have no feel for what is going on?

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  • I have gone down to 5.5 sessions a week now which has helped keep me healthy and sane. If OOH is returned I plan to retire in the next year or two even though I am only in my early 50s. There comes a point where the demands of our customer become so excessive you just decide it's too dysfunctional a contract to continue, and accept the smaller pension. If you think about it you work for thwe difference between your pension and current take home pay - both are heading in opposite directions so the gap narrows each year. in my case it won't be worth the candle for much longer especially if OOH is reimposed and PMS budgets again reduced.

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  • Of course we're p****d off - we 're subsidising the entire NHS pension scheme. Very little reason to work beyond 2015.

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  • I notice how they are looking at cutting the NHS patient contact bit, which is the least profitable, and keeping all the other bits. Surely as a caring profession its the non patient parts of the work that should be cut.

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  • Most of the stress incurred through an increase in workload has been offloaded to practice nurses. They too are considering early retirement. Where is all this going to lead the NHS. Certainly not a "world class NHS", very often quoted by politicians.

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  • Vinci Ho

    I hate to say it but the outside world and the government would not pay any attention to news like this ........or they would and say,'you lazy b******* are still moaning about your money'.....

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