So much has changed in a year. ‘Unprecedented’, ‘challenging’ and ‘pressured’ don’t seem to do justice to just what we – both those of us working in healthcare and everyone else – have all been through in the last 12 months.
For GPs, we were forced to rapidly transform our entire way of working in response to the pandemic. Whether that was by introducing more widespread triage, increased use of remote consultations, or adapting to working full days in PPE, these measures were all put in place to protect both patients and staff, while ensuring that those who most needed our care were still able to access general practice.
But while general practice may look different to what we were used to a year ago, something that hasn’t changed is the high demand on GPs’ and wider staff’s time and expertise resulting in the ever increasing workload we have seen spiral in recent years.
The latest NHS England data shows that there were around 170,000 more appointments in December 2020 than in the same month the previous year, with practices in England delivering an average of around 765,000 each day, despite claims of surgeries closing their doors during the pandemic.
Yes, more of these appointments are taking place via telephone or online, but where clinically appropriate and safe to do so, patients are still being seen in person.
There is a misconception that appointments on the phone or video are somehow ‘easier’ for GPs or take less time than face-to-face consultations, when in fact the opposite can often be true – and most family doctors are missing the regular in-person contact they have with patients, many of whom they will have been seeing for several years.
Crucially, what the NHS England data does not show is all of the workload that falls outside of individual appointments. Traditionally this meant admin, training, paperwork and meetings, and while we have thankfully seen some reduction in unnecessary bureaucracy in recent months, the pandemic response itself has vastly increased these pressure on practices.
The elephant in the room here is the vaccination programme.
We know around three-quarters of vaccinations are being delivered by GP-led sites, so in the first 15 million doses given alone that’s an additional 11 million patient contacts since the programme started – none of which are picked up in the appointments data. This task is even greater when we consider the enormous amount of time required to phone, explain and book all of these patients for their vaccinations.
This is before we consider the mammoth logistical task not just of preparing to deliver the biggest mass immunisation campaign in history in a matter of weeks, but also managing this alongside maintaining non-Covid services for those patients who still need to be seen by their practice.
GPs have always gone the extra mile for their patients – but with Pulse’s workload survey in 2019 finding that GPs were working on average an 11-hour day even before the pandemic, there is only so far they can stretch themselves before they reach breaking point.
In our most recent BMA survey around two-thirds of GPs said their fatigue or exhaustion was higher than normal, while half said they were currently living with a mental health condition made worse by their work.
Not only are there clear safety implications here for both staff and patients, but exhaustion and burnout also risk pushing more talented doctors away from the profession at a time when we are vastly understaffed.
The same BMA survey revealed that more than a quarter of GPs are more likely to take early retirement now, while almost half want to work fewer hours. With fewer doctors, the workload for those remaining in the workforce will only increase further, exacerbating this vicious cycle.
Despite slowly moving past the peak of this massive winter surge, and the excellent progress leading the way in the vaccination programme, it is clear that intense workloads will remain a huge challenge for the foreseeable future, not least because of the scale of the vaccination campaign itself – and that practices will soon be delivering second doses at the same time as offering first jabs to those further down the priority list.
We will need to give colleagues space and time to refresh and re-charge, including taking long overdue leave and then as we get into autumn there will also be the annual flu programme, the potential for further Covid vaccination boosters if they are thought to be necessary, and the need to address the huge backlog of care left in wake of the pandemic.
This last year has shone a light on just how much GPs and their teams are doing on a daily basis, and as we recover from the pandemic and learn from these most difficult times, we must use this opportunity to press reset and tackle the workload crisis once and for all.
Dr Richard Vautrey, BMA GP Committee chair
Pulse is carrying out a snapshot survey on GP workload based on GPs’ day in practice on Monday 1 March. We are asking GPs to take part to help raise awareness about the strain the profession is under.