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Workload survey: ‘We are working beyond the safe level’



‘We have an average-sized practice list of about 7,500. The demographic is slightly above normal in terms of age and deprivation and we’re rural – which is a big factor. I was duty doctor on the day of Pulse’s survey, and I had 124 patient contacts. The median is about 60-70 – beyond a safe level.

‘Patient demand is not the only factor affecting workload.

‘A lot of it is the workload dump from secondary care: decoding illegible handwritten prescription requests; consultants sending patients back to us for referrals to their colleagues, and without giving us the relevant information; chasing up referrals when the patient has heard nothing and can’t reach the secondary care team; and dealing with late or inadequate discharge letters.

‘This workload creates patient safety risks. There are risks around having multiple patient notes open because we’re helping a nurse out with hers, or we’re 30 minutes late so we see the next patient while finishing the notes of the last.

‘We might forget consultant details, plans and actions, or prescribe for the wrong person, use the wrong labels on blood tests, and so on.

‘And the high number of consultations means we haven’t got enough time to deal properly with patients. So, for example, heart failure patients don’t have their medication titrated up, and those with complex combordities aren’t adequately managed.

‘Just this week I sent a blood test using the wrong patient details, simply because I was so busy that safety netting didn’t happen. I spotted it in time, but how many do we fail to spot?

‘I have raised safety concerns with governing bodies before. I was basically told to shut up or my practice would be run over with a fine-toothed comb.’

Dr James Howarth is a GP in Spilsby, Lincolnshire.

He took part in Pulse’s GP workload survey, the results of which have shown GPs are dealing with more patient contacts than they deem safe.