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UK doctor leaders back calls for workload cap ‘to protect sanity of GPs’



Doctors from across the UK have backed calls for the introduction of maximum workload limits for GPs.

The BMA’s Annual Representative Meeting voted in favour of a motion urging that a ‘sensible cap is agreed on the workload that a GP can be expected to be safely deliver in a day for the safety of patients and sanity of GPs’.

This follows last year’s vote in favour of introducing hospital-style ‘black alerts’ in GP practices, when patient safety could not be guaranteed.

The BMA’s GP Committee published guidance proposing four ‘operational pressures escalation levels’ in March this year, however at the time NHS England said ‘arbitrary caps on patient appointments would breach GPs’ contracts’.

Speaking in favour of the motion, Dr Mary McCarthy, a GP in Shrewsbury, said: ‘It’s not that I necessarily want them as a definite limit. What I want people to recognise is that seeing 25 patients a day is a reasonable amount of work to do. Seeing 50, 60, 70 patients a day, every day, year on year, is not safe. It’s not safe for the doctor and it’s not safe for the patient.

‘I think this should be viewed like a speed limit – and I speak as someone with points on their licence – that there are occasions when you do break it. That there are obviously flu epidemics or a busy day, in which you do see more. But that you do recognise that you’re working at an unsafe level.’

Speaking against the motion, Tower Hamlets LMC chair Dr Jackie Applebee said: ‘General practice is in meltdown, we can’t go on as we are, but what would a sensible cap be and how would we enforce it?

‘Some suggest limiting consultations perhaps to 25 a day but how many of us would turn away our 26th patient when for example they’re an 85-year-old who struggled to get down to the surgery. We are notoriously bad a saying no and no more so than to our registered patients.’

Dr Richard Vautrey, chair of the BMA’s GP Committee, said: ‘We have started working on this. We have produced a paper, describing how we can provide some safe limits for practices – how they can take control of that but clearly we need the investment as well to enable that to happen on a sustainable basis. But the way that this motion is phrased, we do believe you could accept it because it is helpful in terms of moving that agenda forward.’

Also at today’s ARM, which is taking place in Brighton, a motion calling on the BMA ‘to take urgent action to ensure the protection of “last man standing” GPs from any additional costs of resignation or retirement resulting from practice closure’ was voted through unanimously.

In a speech introducing the GP section of the meeting, Dr Vautrey said: ‘For far too long our service has been undervalued and taken for granted.

‘GPs’ work ethic and dedication to their patients has been exploited through a decade of underfunding and soaring workload pressure, with the assumption that the GP practice will always be there to pick up the workload that others say they cannot or will not do.’

Pulse revealed last month that one in six GPs has already had to turn away patients for routine appointments due to unsustainable demand in the past year.

Motions in full

GWENT AND SOUTH POWYS DIVISION: That this meeting urges a sensible cap is agreed on the workload of a GP which can be expected to be safely delivered in a day for the safety of patients and sanity of GPs.

CONFERENCE OF LMCS: That this meeting is concerned about the number of recent practice closures and:-

i) believes that unmanaged dispersals lead to patient safety issues;

ii) believes that more needs to be done to make the public aware of the mounting threat to the system of general practice;

iii) demands details of the contractual arrangements to provide ongoing primary care after a practice closure, are made public;

iv) instructs the BMA to take urgent action to ensure the protection of ‘last man standing’ GPs from any additional costs of resignation or retirement resulting from practice closure.

Source: BMA