Around 40% of GP practices implement a maximum number of patient contacts a day, a Pulse survey has revealed.
The survey of 408 GP partners asked respondents whether they apply a daily limit on the number of contacts or consultations per GP.
Many of those who do cited the need to operate within safe limits, and some also emphasised that any cap is flexible based on clinical judgement.
Pulse’s survey, which had 860 GP responses in total, also revealed that the profession sees an average of 37 patients within a full-time day.
The BMA’s guidance on safe working recommends that GPs should have no more than 25 contacts per day in order to deliver safe care, however Pulse recently reported that NHS England does not recognise this ‘arbitrary’ workload limit.
Dr Tim Bates, GP partner at Fort House Surgery in Surrey, said he and his colleagues did not want to implement a maximum number of patient contacts, but ‘workforce and capacity demanded it’.
He said: ‘Our maximum number is now 36. We used to close the website to new enquiries, though phones were still active with partners and enthusiastic colleagues providing extra capacity. Then a November redesign of the appointment book stopped this happening.’
A GP partner in North East London, who wished to remain anonymous, said the problem is that general practice is seen as a ‘limitless resource’ but that ‘everything comes back to us’.
His practice has implemented a daily 25-patient limit per GP, as per BMA safe working advice, but he said this does not account for the ‘up to 75 to 100 pieces of correspondence that come in from secondary care’ which require action.
He told Pulse: ‘The thing we need to emphasise is that this is not about sloth, this is not about keeping things under control – it’s about keeping things safe. That’s why we do it.
‘I’ll work as hard as a Trojan, but ultimately I need to be focussed on the people that we see. The nominally 10-minute GP consultation is some of the most intense activity that any healthcare profession does.
‘I’ve always told my trainees that we are teaching them to pull off miracles at 10-minute intervals throughout their whole career, day in and day out.
‘You need to be 100% sharp, you need to be picking up on cues, you need to be very, very alert, and safe in that.’
Some GPs stressed that their cap on contacts is flexible to meet patient needs and to address urgency where needed.
Dr David Coleman, GP partner for Conisbrough Group Practice in Doncaster, said they do not implement a limit ‘rigidly’ as each patient contact is different and ‘adhering to a specific number feels unreasonable’.
He said: ‘20 sore throats are not the same as 20 palliative care home visits for example. We make a judgement about clinical capacity and use care navigation and triage to ensure we operate within our safe limits.’
When planning clinical capacity, GPs must also factor in time for supervision, training, administration, and triage, according to Dr Coleman.
Similarly, a GP partner in Shropshire, who wanted to remain anonymous, told Pulse that their patient limit is implemented with ‘clinical discretion’ meaning often more patients are seen.
GPs at her practice each see a maximum of 30 patients by phone or face-to-face on a daily basis, while phone or online queries via reception are unlimited.
She said: ‘If we are full patients are advised to contact an alternative provider or ring tomorrow. If receptionists are concerned that a patient appears significantly unwell when calling for an appointment and we are full, they will speak to the duty doctor who will then decide what to do.’
However, Dr Zishan Syed, a GP partner in Kent, highlighted the issues practices experience when trying to signpost patients to other services, saying the ‘system will not accept that GPs are full and treats GPs as having infinite capacity’.
He said: ‘The 111 service deliberately includes wording in its summaries with ridiculous time frames that scare and mislead patients to request an inappropriate immediate review. If practices divert to 111, then 111 simply makes them bounce back to us.’
RCGP chair Professor Kamila Hawthorne said GPs ‘need to be able to practice safely and effectively’, both to protect patient’s and their own health ‘to avoid burnout’.
She said: ‘No two appointments in general practice are the same and patient contact numbers will vary depending on which clinical healthcare staff member is seeing the patient, practice and patient circumstances, and clinical judgement.
‘Practices will manage this in the best way they can, based on their knowledge of their local patient population. However, there comes a point where demand exceeds capacity and GPs can no longer guarantee safe care to their patients, so we urgently need to find a range of solutions to this.’
Last week, Pulse reported from its survey that almost a third of GP practices have been forced to stop routine care in the past year due to overwhelming demand.
The imposed GP contract for this year stipulates that GPs must offer patients an assessment or signpost them to an appropriate service on first contact, meaning they can ‘no longer ask patients to contact them at a later date’.
The GPC England has made clear that this new contractual obligation does not mean having to offer patients an appointment on first contact.
Pulse’s survey was open between 9 and 15 June 2023, collating responses using the SurveyMonkey tool. A total of 408 GP partners from across the UK responded to the question on limiting contacts, with . The survey was advertised to our readers via our website and email newsletter, with a prize draw for a £250 John Lewis voucher as an incentive to complete the survey. The survey is unweighted, and we do not claim this to be scientific – only a snapshot of the GP population.
Pulse survey results in full
Do you implement a maximum number of patient contacts/consultations per GP per day? Yes 39.71% 162 No 59.31% 242 Don’t know 0.98% 4 Answered 408 How many patient contacts do you have in an average full-time day? 0-5 1.16% 10 6-10 1.51% 13 11-15 0.81% 7 16-20 2.21% 19 21-25 6.05% 52 26-30 22.44% 193 31-35 20.00% 172 36-40 17.44% 150 41-45 7.09% 61 46-50 8.14% 70 51-55 1.98% 17 56-60 3.26% 28 61-70 1.51% 13 71-80 1.05% 9 81-90 0.81% 7 91-100 1.05% 9 More than 100 (please specify) 1.51% 13 Don’t know/not applicable 1.98% 17 Answered 860