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Clock off at 7pm? If only

After hearing Jeremy Hunt’s message that GPs need to stop clocking off at 7pm, a number of GPs tweeted about the reality of their working day:

‘In at 8am, out at 20.00pm, stuff left undone…’

‘Clocked off at 9.45pm yesterday after an 8am start’

‘GP mother, came home at 10pm last night. Was in at 7am #thenorm’

‘First patient 07.30am; logged out of computer 11:30pm. Selfishly took an hour and half off at 7pm to go home, no lunch tho’

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The Northern Ireland GP workload survey is the most up to date comprehensive study we have on GP workload. It takes into account complexity of general practice and has recorded activity outside of consultations. It covers an 11-year period from 2003-2014. The data shows that the number of test results dealt with by practices increased by 217% in a decade and administrative tasks by 115%. It also shows that the average GP carries out 47 consultations, signs 172 prescriptions and files 35 lab results per day, equating to a minimum of 11.3 hours every day. And the work doesn’t stop there.

We keep saying we’re working flat out – having 60 contacts a day or more – but we still haven’t yet undertaken a UK-wide piece of work that could help us identify where and when we may need to draw the line. Nor have we asked when GPs being this overworked might begin to affect patient safety. This does us adisservice. Supportive, sympathetic organisations such as The Kings Fund, The Nuffield Trust, and the DDRB recognise we’re working flat out, but there’s simply no definitive evidence that could help us work out how to bring about positive change.

The last UK-wide workload survey was carried out in 2007 and only really looked at patient consultations; it did not reflect the complexities nor record additional activity. Any current day data presented on workload is simply based on an extrapolation from this old data. The 2007 survey recorded that full time GP Partners (full time being regarded as those who worked 8 or more sessions per week) worked on average 44.4 hours. What’s also interesting is that QOF had only just been introduced in 2004 and other bureaucratic measures followed much later. This survey is clearly well out of date. 

Two out of three GPs are facing significant work related stress, nine out of 10 GPs state that workload pressures are damaging quality of patient care. And this is reflected in our workforce, with ever increasing difficulties being faced in recruitment and retention.

What we need now is to build on the great work done by Northern Ireland GPC. We must conduct a workload survey across the UK in collaboration with other stakeholders to help us define what’s safe and what’s sustainable in general practice. Only then can we put in place structures to support and rebuild the profession. 

Dr Farah Jameel is a GP in London and a member of the GPC