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The maths don’t work

The maths don’t work

I am a lowly humanities graduate, so can someone with a mathematical bent help me? GP workload was too big pre pandemic. Towards the autumn, more workload was added to their pre-pandemic levels as a result of catching up from the first lockdown. Then more workload was added through the extended flu campaign, the biggest vaccination programme ever carried out in the UK. Now more workload has been added by the Covid vaccination programme, which makes the flu campaign look tiny in comparison.  

What has been subtracted from their workload has been… er, maybe CQC inspections, maybe a bit of QOF.

This doesn’t add up. The only concession that’s been given for the Covid vaccine programme is £150m given to CCGs to support practices in offering more sessions to salaried GPs, or getting staff to return to the NHS. Yet even this money comes with strings attached, with GPs told they must return activity to ‘at least prior levels’ and make ‘significant progress on learning disability health checks’.

The GPs I speak to all understand the importance of this vaccine. They didn’t get into medicine for the money, whatever some elements of the reactionary press say. It’s not even about making profit.

The fact is, there are physically not even enough hours in the day for GPs to carry out the work expected. Even if – as could be the case – you make them work on Christmas Day.

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


Andrew Jackson 11 November, 2020 1:15 pm

All the additional roles we have employed have work load control and love primary care. When our pharmacist has finished the agreed prescription work the overflow passes to the GPs!! and they go home.
When will our leaders secure the same for us.
I don’t have a single friend who works outside of medicine who doesn’t expect to work a 5 day week yet we have got to a point where we can’t offer a full time career in General Practice due to burnout due to work intensity.
We will of course sort out Covid vaccinations even if many of us give up even more of our free time but after this we need to draw a line in the sand.

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A non 11 November, 2020 2:15 pm

I’m sorry but to suggest General Practice is currently overwhelmed with ‘all this extra work’ just doesn’t square with the reality on the ground. Prior to the pandemic General Practice was rushed off its feet, There were too many patients and not enough hours in the day to offer all the appointments that were being demanded. When covid hit face to face appointments became severely limited, everything is triaged by phone and vastly fewer patients are being seen face to face. As a locum – almost over night – work disappeared. I simply wasn’t needed. When I do get a session I’m on the phone or sending text messages and maybe seeing the odd patient in PPE. If you want to know ‘whats been subtracted from the work load’ i’ll tell you..its the mountains and mountains of trivial unnecessary consultations that were clogging up the waiting room prior to covid (and no doubt a whole load of very necessary stuff too) ..folk just aren’t being seen like they used to be. If GPs are so busy..why doesn’t anyone need to hire locums any more? The reason is bloody obvious but it doesn’t fit with the ‘over worked GP’ narrative. Stressed? probably. Struggling to work out how to manage all the instructions from NHS England etc? probably, but understaffed and lacking access to man/woman power? No they aint

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Patrufini Duffy 11 November, 2020 2:56 pm

A non. Fair assessment. I think what is exhausting is the pulling, tugging, bending and chucking done by NHSE, and ruthlessness to contractually enforce things upon individual practices. The pointless schemes, delayed payments and hospital liberties – and a PCN-DES that quite a few sheep signed up for, without reading the contract. The PCN is an inert entity, NHSE successfully created it to decimate the individual practice based decision. So, btw scrap your hallowed PPG and FFT – its ENTIRELY irrelevant in a cunning PCN landscape.

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Dr N 11 November, 2020 3:32 pm

A-non thats total rubbish. We are seeing more trivia than usual because its now so easy to have a consultation with your GP from your sofa supping a cuppa whilst Loose Woman is on in the background.

We have stopped employing locums because practice profits will be hit this and probably next year; Reduced private work, no minor ops and local quality outcomes. All partners have not taken their full quota of leave this year.

Stuart Hazle 11 November, 2020 3:57 pm

As a retired GP/Locum viewpoint:
It has always been the case that DoH puts more and more “work” and admin onto GP practices, with never any consideration of what work we can stop doing to allow time and resources to do the extra things.
This year it’s the same but “on steroids”.
The best defence is not to agree to take on the work deemed “un-doable”; but I’m afraid most of the profession do jump to agree for any extra funds despite the logistics being against them.
PCN’s are a case in point – I knew of very few GPs who thought it was a good idea, but all signed up!
As always, we would be stronger if we acted together, on agreed clinically important principles, and insisted on adequate financial resources and sensible time-frames.
Solidarity is your best bet.
Your ability to learn from past lessons is against you.
Good luck; I don’t envy you.

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gregory rose 11 November, 2020 4:34 pm

Lets just say Dr N is a lot more aware of what is going on that A Non – who is anonymous for reason. It was quiet during early lockdown, deadly so. It hasn’t bene for a long time now though. There may be other reasons you aren’t wanted…

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A non 11 November, 2020 6:10 pm

Locum Dr bookings are down across the entire country Gregory Rose – your suggestion thats its a personal issue just doesn’t add up, if you guys are so terribly busy why is no-one hiring help anywhere?? The anonymous Dr N you are speaking total and utter rubbish. I work across multiple practices – they are all ghostly quiet, patient contacts are massively down, I suspect you’d struggle whatever is going well on..

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Finola ONeill 11 November, 2020 8:31 pm

Ghostly quiet. Is this a hoax. We are busier than usual. And knackered. I think primary care leading on vaccination program is ridiculous. This vaccine needs storage at -70, 1000 doses per vial and 5 days after vial is defrosted to give them all. It’s not a medical issue, it’s a logistics and distribution issue. I think the army would do it best with GP surgeries advisory to locations, asking patients if they want to sign up and getting permission to share info. The mobile people will go to the pop up vaccination centres and all the bigger centres. GPs will be left with the housebound, isolated and are homes. The number of home visits this will create is unmanageable and the numbers don’t work. OUr PCN in rural devon is a 2 hour drive from one surgery to the furthest and we have about 70 care home patients between us. Go figure. If PCNs and surgeries sign up for this they are mad. We can’t make it work. It is bad use of our time, knowledge and skill set. We know our patients well and have enough work with clinical stuff. This work is better done by someone else to organise it and others to give it. What happened to all those allied professionals they trained?

john mackay 11 November, 2020 9:40 pm

A Non, you are Matt Hancock and I claim my five pounds!
Step into the real world.

A non 11 November, 2020 10:06 pm

Unless someone can explain why nobody is hiring locums you can whine all you like. I’m sorry but “you’re all shit and/or too expensive” doesn’t cut. You were hiring before the pandemic and now you are not. We were all just as shite and expensive before covid. If you are all so desperately and overwhelming busy why have you stopped hiring help? I expect nothing other than a heap of bleating and victim speak in response, but it doesn’t change the facts. You aren’t hiring. Locums aren’t needed. Locums aren’t needed because theres no work for us to do. It’s simple. If you are working 14 hour days and can’t afford to hire staff might I suggest you either get a practice manager or have a quiet chat to the one you’ve got. Enough already.

David Banner 12 November, 2020 9:45 am

“Children!! Play nicely please”
This Locum vs Partner spat really needs to stop.
Most partners are dedicated hard working souls, some are lazy and greedy.
Most locums are dedicated hard working souls, some are lazy and greedy.
Most partners have forfeited annual leave this year because there’s nowhere to travel to.
Most consultations this year were done remotely.
Many partners will see a fall in profit this year for various reasons, so need to save on Locum costs.
Hopefully 2021 will see a return to normal, and our symbiotic relationship will resume.
2020 has been a surreal, weird and hopefully unique year. We should be pulling together as a profession, not tearing strips off each other.
Shake hands??

Mr Marvellous 12 November, 2020 12:03 pm

A-non’s view is irrelevant (from a Practice perspective).

We know how much we earn
We know how hard we’re working
We know how much locums cost

The decision to get locum help (or not) is based on the above and other factors. If it was worth it to us, we’d do it.

At the moment it isn’t. Surely you priced this into your business model?

John Graham Munro 12 November, 2020 4:04 pm


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