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The ‘part time’ fallacy

practices businesses

You may have seen the front page of the Sunday Times this week (in which – shameless boast – yours truly was quoted).

Most of the piece is fairly balanced, pointing out that a full-time job in general practice is simply not doable and cutting hours is pretty much the only course of action.

(When I spoke to the journalist, I stuck to my own advice to emphasise the only salient facts – that full-time equivalent GP numbers are going down at the same time as demand is increasing, and all else is noise, and I think a lot of the piece reflected this).

However, the opening line – obviously the most important one – was problematic: ‘Nearly a fifth of GPs work an average of only 26 hours a week as half of all patients struggle to get through to their family doctor, data suggests.’

I don’t think there is any other profession whose headline working hours are based on the 20% of people who are doing the least hours.

However, I also think that this neutralises pretty much the only argument that GPs themselves are to blame for waiting lists – which is that access is suffering because GPs are choosing to work less than full time.

There is no doubt that GPs are cutting hours, and mainly for good reasons. But – despite the increase of GPs doing ‘part-time hours’ – the average working week for GPs remains at around 40 hours, five hours longer than a traditional 9-5. And the 20% doing the least hours in the NHS still work a mere nine hours less than a normal full-time job.

Of course, even those who do work a pitiful (ahem) 26 hours in surgery often have other roles, many mandated by government (PCN leads, commissioning roles, LMC work, etc), or are looking after families.

Harking back to the days when GPs did work longer hours also ignores how intense the work is now, where any error in the churn of ten-minute appointments can lead to patient harm (and the end of a career too). In the good old days, a GP might work longer, but with the lower demand and with less jeopardy, there wasn’t the same level of burnout.

Which is all to say that part-time GPs are not really part time. And even calling them ‘less than full time’ doesn’t fully convey the actual hours they do, and the work they get through.

I think a lot of professions – my own included – would struggle with the hours worked by ‘part-time’ GPs.

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

READERS' COMMENTS [7]

Patrufini Duffy 27 July, 2022 6:34 pm

If some of the noisy public actually went full-time, and stopped winding themselves up, a lot of the nonsense clogging the NHS would stop. Period. You see it in other worldly countries. Living life and being too productive to chat about your bloating and one day itchiness and mole that never changed, and your diarrhoea after a kebab at Glastonbury and UTI post prosecco brunch and panic attack after breaking with your boyfriend. This is what is clogging GP appointments. Chit chat. That you’ve read you could have ADHD but clearly, you don’t. You just thought it was fashionable and wanted to block an appointment from someone else. And you’d get more GP appointments for those in need if you sorted the mess going on between ages 20-35. The system is dishonest and fobbing of the sick and infirm, for the loud noisy bored and anxious ones. The self-entitled. ***It will never get called out. And we could clear the 30% time-wasting nothingness blah blah “let’s make up a story” and “get something for nothing” and save outpatients too and open access. Trivial banter. Boredom and self-made anxiety and scrolling does nothing for wellbeing. That’s a fact, like when the World Cup is on, summer and Christmas holidays – miraculously everyone got cured then. Because they had something else to do. And the system recovers, but only momentarily. Addiction like a trip to Weatherspoons and loving it in Malaga.

David Mummery 27 July, 2022 6:45 pm

Thank you Jaimie for all your support and the massive support for GPs at PULSE. Hugely appreciated!

Vinci Ho 28 July, 2022 9:58 am

It is difficult to see a way out in terms of changing public opinions on GP working hours . This is certainly not helped by ruthless media with little sympathy.
It is still going back to terms and conditions of our contract(s) which is clearly nothing to do with number of working hours. It is so easy to criticise that some GPs work less hours . The reality is ,the number of hours dealing with patients ( remote or face to face) is much overshadowed by hours dealing with associated bureaucracy(not helped by a broken secondary care referral system, for instance) and box-tickings . The efficiency of sorting out one patient is much reduced because the final completion time is much longer than official appointment time .
The average time spent on sorting out a patient , particularly the complex ones , is the actual figure to concentrate on ( as if these media are ever interested!) . Officially part time GPs often ends up working much longer hours and full time ones work seriously overtimed . Yes , you can argue this happens to all other professions . But we are also talking about the bagged of medico-legal liabilities , over-regulations and obviously, the repercussions of more GP colleagues leaving earlier.
No matter what , thank you for your support , Jaimie

Andrew Jackson 28 July, 2022 11:44 am

I have no friends who don’t go to work on a monday morning and finish on a friday evening unless they have an illness or caring commitments.
We should expect to do all our work including training and CPD, appraisal, CQC etc in a standard week that is sustainable for a whole career but we should also expect ourselves and our colleagues to be in work every day.
This would improve our continuity, build better teams and avoid the notion that we are part time.
Maybe a 5d salaried contract incorporating all
if this is the way to go?

A Non 29 July, 2022 8:50 pm

Excuse me but it isn’t illegal to work part time. Neither are people who do somehow morally or ethically inferior. I work part time because the job is so utterly stupid I’d go insane if I worked full time. I’ve done it and it almost sent me nuts. I’m not somehow ‘lacking’ or ‘not up to scratch’ or ‘lazy’ or whatever ignorant patronising bullshit judgment you want to take from the comfort of your armchair..the job is undoable full time. As for the inevitable response of the dwindling few who still are who say ‘I’m doing it..why don’t you you lazy arse?’ I’m sorry but the statistics scream it out loud and clear. People aren’t! You simply can not get to become a Dr by being pathologically lazy. A GP qualification doesn’t somehow suddenly program you to sit at home half the week gardening. It’s the job ..stupid. I simply can not agree with the editorial position on this ..which appears to be one of denial..’it isn’t happening’ ..because if it was ‘I kind of agree they must be a bunch of lazy layabouts’ Can I say it again. Its the job. The job is the problem. Not the staff. No wonder we are all getting roundly done over year after year. Who represents all those people who’ve left to become Locum’s, all those people who have quit entirely..all the ‘half wits’ only working part time ..NOBODY. All we get is the failed and failing opinions of the fools who have been left behind seemingly content to continue on year after year in idiotic conditions. They may grumble but what do they actually do..nothing. the people who could , already did..they left. Or went part time

Gerard Bulger 30 July, 2022 6:47 pm

We have two options.

1 Scrap general practice and be part time salaried employees in a hospital type setting. That’s were the punters want to go, where the scanner is, and GP are part salaried time now and prefer to be in a large team. Part time is an issue because that working has introduced inflexibility to meet short term demands (pre-holiday inspection syndrome is a main one), leaving permanent long waits. GPs have broken up into specialists creating need for multiple appointments, then wonder why there are none.

2 Retain General practice but move to Australian type fee for service. Longs waits don’t exist there even in areas of doctor shortage. Imagine receptionists TOUTING for customers! I cannot tell you how much better it felt doing an exhausting busy day seeing 35 patients face to face, as the wallet was bulging. We need to stop patient churn, so a fee structure like this: little pay if patient last seen in last two weeks, more if not seen in three months and a fatter fee if patient not seen for a year or more Extra top up for complex or elderly or secondary care dumping. Then pay extra once fee once doctor have reached 25 face to face a day, with a top limit of 45 patients. In Australia if I saw zero patient my pay was zero. In UK there is almost NO correlation between patients seen and income. This is an error.

Imogen Bloor 1 August, 2022 7:26 pm

Yes, thank you Jamie. Part time hours are just indicative- in reality many (if not the majority) of part-time and full time GPs work well beyond their contracted hours. A ‘session’ is 4 hours and 10 minutes, so a notional 26 hour week is just over 6 sessions. If sessions run late (which is not difficult if you include a 3 hour surgery, one or two very complex patients or an emergency, referrals or dealing with Advice & Guidance responses, checking & actioning letters & results, doing repeat prescriptions etc the 26 hour working week can very quickly be considerably more, especially if you add in attending Practice meetings, educational or system meetings & webinars, learner support etc. These things are often NOT included in rostered hours. Whilst the BMA model contract serves to ensure all these responsibilities are factored into a structured work plan, very often that does not happen. There are innovative ways of improving work planning & delegating some of this work to trained clinical administrators or the extended primary care MDT work force but my sense is we have a long way to go before such strategies are consistently implemented to hep manage work load. And as Jamie also points out, many ‘part-time’ GPs have other non clinical leadership roles which need to be filled by Clinicians. Whilst patients may not understand the huge amount of work that goes on behind the scenes ( ie: a GPs job is not just direct patient contact) and a few may have unrealistic expectations, I don’t personally feel blaming patients for contacting us over seemingly ‘trivial’ issues is either an accurate or helpful explanation for the situation Primary Care is in. .