The biggest threat to UK general practice isn’t underfunding, poor recruitment, or the tendency some secondary care doctors have to treat us as their community-based house officers. The danger we face is proliferating constantly, and has seeped into every aspect of our working day: ‘magic time’.
Nowhere is this more apparent than in the Daily Mail’s recent sensationalist front-page story about GP opening hours.The Mail lambasted the 46% of surgeries that close during core hours, in terms which suggested that we all down tools every lunchtime for a siesta and close one afternoon a week for a few rounds of golf. The most juicy aspect of the report – the fact that the Commons Public Accounts Committee (PAC) said that the Government’s promised seven-day access may, at great expense, simply duplicate existing out-of-hours GP provision – was buried halfway down the page.
The Mail describes surgeries that close in this way as ‘failing’ their patients. Underneath the emotive language, the paper is describing an attitude which is becoming only too common in modern primary care: that the only work which counts is seeing patients.
The average Daily Mail reader would, no doubt, be incensed if they requested a repeat prescription and it could not be issued because their doctor was so busy consulting that he did not have time to reauthorise the script. Even the erstwhile members of the PAC might raise an eyebrow if they rang their own surgery to ask about their blood results, and were told, in perpetuity, that the GP had not had time to look at them yet because she was seeing patients.
Practices that close during core hours do so for all kinds of reasons, and the PAC report acknowledges that workforce shortages mean that there are not enough GPs to meet demand. NHS England told the Committee that the main reason for GPs leaving the profession is workload. Yet the Daily Mail’s stance seems to be that GPs should not have any allocated time in which to complete the large chunk of their workload which is not direct patient contact.
Every GP knows that blood results, prescription reauthorisations, and hospital letters can add hours to the working day, and that’s before considering non-NHS work like insurance reports and medicals. Such work forms a vital facet of patient care, and we need time in which to do it. If some surgeries have found that the best way to create that time is to close the front doors for a few hours a week, and they are able to do this and still meet their patients’ needs, then why not? Do the members of the PAC feel they know more about how to deliver patient care than GPs who work on the frontline day in, day out? If surgeries are no longer allowed the freedom to manage their (considerable, and growing) workload as they see fit, then when will non-patient-facing work get done? Does the Daily Mail think that we can conjure extra hours into our working day – or, more likely, do they simply not care if GPs have to stay in the surgery for many hours after the doors have shut every night?
The Mail would have you believe that there is a great tidal wave of unmet need which is crashing against closed surgery doors while GPs are off playing golf. Unsurprisingly, the evidence does not back this up. A pilot of GP extended hours in Manchester demonstrated little impact on walk-in centre or out-of-hours GP attendances, suggesting that increasing access might have increased demand. This reinforces what most GPs know to be true: that the easier you make it for patients to see you, the more likely they are to consult you with a cough they’ve had for six hours, or because they want ‘a letter for the housing’ saying their council flat is haunted.
The proposed new GP trainee work schedule is a perfect example of ‘magic time’. In order to comply with the new junior doctors’ contract and work no more than 40 hours per week on average, NHS Employers have produced a document suggesting that GP trainees should be spending up to six hours a day offering face-to-face appointments while managing to fit their admin into an unfeasibly short window. For example, on Fridays the model timetable suggests that trainees should have an hour set aside for ‘admin/visits’. There are plenty of qualified GPs who would struggle to do their day’s admin in an hour, let alone squeezing in a home visit as well. In reality, trainees will learn to do as qualified GPs do – come in early, or stay late, or catch up with their admin on their half day – but the model timetable neatly demonstrates that the powers that be either do not know, or do not care, how hard GPs work, and that they do not value our non-clinical time.
Some GPs are guilty of propagating the myth of ‘magic time’. I am approaching the end of my training and have been looking for a job. Having read countless job adverts and visited many prospective surgeries – not to mention talking to friends about their workplaces – I have encountered more than one GP who nonchalantly boasts about being out of the door at 6.30pm sharp on a duty day, without acknowledging that they come in at 7am every morning to clear their admin. I don’t criticise them for that – the work exists and needs to be done. But I don’t think that playing down our workload, and pretending we have a better work-life balance than we do, will do GPs any favours.
I think it’s time for a bit more honesty – from GPs, from those who contract with us, and from the public – about the work that we do. Only then will we stand a chance of being funded and resourced appropriately.