Pulse May 2019 issue - Page 7

7 from GPs from across the UK; some even contacted us with anecdotes on behalf of colleagues too busy to do it themselves. The message was clear: GPs are indeed working above safe limits. As the Hertfordshire GP put it: ‘It now feels that we are mere processing lines for patient problems – the conveyor belt effect. ‘You feel stressed out, mentally and physically exhausted, and more likely to give in to patients’ demands, and later regret doing so. This can affect your confidence in patients’ future care. What’s more, it affects your home life too.’ RCGP chair Professor Helen Stokes- Lampard is another feeling the strain. She says: ‘In my own practice recently, I had a 12-hour day and 100 patient contacts – GPs across the UK will tell similar stories.’ The potential effects on patient safety are concerning. Most shockingly, 52% did not feel they were working at a safe level that day. Yet the majority said it was a typical day. The survey asked GPs to estimate a safe number of patient contacts; on average they had 37% more than they deemed safe. Around one in 10 reported 60 contacts or more in a day – double what respondents consider safe. And many contacts were far from simple. Although there was a mix of face-to-face, phone and online consultations and home visits, respondents said 29% were ‘very complex’ and 37% ‘fairly complex’. The average eight hours of clinical care exceeds the scheduled, with partners facing the longest days (see box). This huge workload burden has an effect on patient safety – and GPs’ own wellbeing. Professor Clare Gerada, former RCGP chair and an expert on GP burnout, says: ‘In general practice, you’re using your brain all the time, constantly, and every patient could be anything from a minor sore throat to lung cancer. You have to concentrate on every single patient. ‘There’s no adrenaline, it’s very mundane, so it’s easier and easier to make a mistake if you get tired.’ She says the high number of patients GPs are seeing is more likely to lead to tiredness – and possible mistakes. She adds: ‘You could miss a result or misread a letter, or you don’t focus on the right symptom or ask the right question. You might put yourself at risk. ► 3 hours of admin Type of GP Gender diff erences Key GP partners Salaried GPs Locum GPs GP registrars Key Men Women Average number of patient contacts Scheduled to provide more than 10 hours of clinical care 41 24.6% 36 13.9% 30 26 Scheduled to provide more than 10 hours of clinical care 23.4% Actually providing more than 10 hours of clinical care 28.1% 28.6% 11.4% Actually providing more than 10 hours of clinical care 30.9% 27.5% Partners have more patient contacts than other GPs, are scheduled to provide more clinical care and do actually provide more hours of clinical care. However, salaried GPs are more likely to provide clinical care beyond their scheduled hours. GP burnout expert Dr Clare Gerada says the workload for GP partners, in particular, is ‘unsustainable’. She says: ‘If we lose the partnerships, we’ve lost general practice. Partners are essentially caught up in having to keep the whole machine going and nobody’s helping. ‘Unless there’s a way in improving the benefi ts of being a partner, then what we’ll fi nd is more and more partners will burn out.’ These results confirm GPs are working far beyond capacity Dr Matt Mayer Women are more likely to provide more hours of clinical care, despite being scheduled for shorter hours. BMA GP Committee workload lead Dr Farah Jameel says: ‘We know women may be more likely to actively seek out reduced contractual hours due to family and other commitments, so if female GPs are routinely working beyond their structured hours, it can have a real damaging eff ect on doctors’ wellbeing and home life. ‘And most importantly it will continue to increase the unacceptable gender pay gap, which must be addressed immediately. ‘This workload burden will also do nothing to improve the longstanding under-representation of women among GP partners.’ Practice size Key 10,000+ patients 7,001-10,000 3,001-7,000 0-3,000 GPs providing more than 10 hours of clinical care 31.6% 29% 23.9% 12.5% Source: Pulse’s GP workload survey, conducted on Monday 11 February. Results are based on responses from 1,681 GPs, who were scheduled to work a mixture of part- and full-time hours Tower Hamlets LMC chair Dr Jackie Applebee says: ‘Governments across the UK are moving towards bigger practices through networks, clusters or federations. Yet the survey reveals GPs in larger practices are more likely to work long hours. ‘I work in a small practice and we all know the regular attenders and more complex patients. If a complex patient has to see a diff erent GP each time, that might add to workload.’ Walsall LMC chair Dr Uzma Ahmad says: ‘On funding, the Government thinks it’s better for a bigger practice, but for patients, smaller practices provide more continuity of care.’ Pulse May 2019