Pulse May 2019 issue - Page 8

8 Cover story You might end up being rude to a patient and then get a complaint, because when you’re tired you become irritable.’ Nottingham GP Dr Jonathan Harte, who took part in Pulse’s survey, says he felt the risks to patient safety grow throughout the day. He says: ‘By lunchtime I felt on the edge and risked missing urgent tasks and contacts, thus affecting patient safety. I did miss the fact that a patient I had tried to contact earlier in the day had called back, so I didn’t call her back before the surgery closed.’ The UK is an anomaly in terms of patients contacts. Dr Mary McCarthy, vice-president of the European Union of General Practitioners (UEMO) and a GP in Shropshire, says ‘25 or fewer consultations a day’ is common according to surveys of European doctors. Dr McCarthy says in European countries, a GP’s workload is balanced out in accordance with list size. ‘In a lot of European countries, GPs are limited to 1,000 patients. In Italy for example, if you go over 1,000 patients, you have to employ another GP.’ In November in Spain, when workload became unmanageable, GPs even took to the streets of Barcelona as the Doctors of Catalonia union demanded a cap of 28 patient consultations per day and minimum 12-minute appointments. Workload survey: daily patient contacts Pulse May 2019 36 37 57% 68% 8% ■ % of GPs that had more than 30 patient contacts ■ % of GPs that had 60 or more patient contacts 40 76% 14% 10% North West North East and Yorkshire 38 64% 7% England 39 71% 10% Wales 37 64% I   n England, the key driver of increasing workload is well known – a lack of GPs. In February, it was revealed the number of full-time- equivalent GPs had fallen by 2% in a year – just the latest in a long line of worrying figures. A report in March concluded the NHS will have 7,000 fewer FTE GPs than needed within five years. 1 Practice closures are also an ever- present threat. Gloucester GP Dr Sally McNabb says staff shortages and retirements mean her practice is at risk of ‘imminent closure’. She says: ‘The only full-time partner is emigrating later this year taking with him his partner, who is our excellent diabetes nurse. This leaves us massively understaffed in a climate that makes replacing them unlikely. All the doctors who could retire have done so.’ Increasing patient demand has even more impact, yet seems to be actively encouraged by the Government, especially in England. It continues to push its routine evening and weekend GP access policy, despite patchy appetite from the public. Health secretary Matt Hancock has been much criticised by GPs for statements encouraging unofficial screening – including gene testing. This follows Public Health England’s ‘heart age test’ campaign, which told people to see their GP if they don’t know their blood pressure. NHS managers have started to take notice of this cocktail of factors and insist ■ Average number of patient contacts in a day Scotland Northern Ireland 9% 41 75% 7% 40 75% Midlands 9% 39 72% 11% East of England 37 London 70% 9% South East Note: patient contacts are based on all GPs – not just those working full time 39 South West 72% 10% they are working to reduce GP workload. In England, the new contract agreed by the BMA and NHS England includes an annual £891m by 2023/24 for practices in networks to hire 20,000 extra healthcare professionals. An NHS England spokesperson says: ‘We know general practice is under pressure. Investment in local doctors and community services is increasing by £4.5bn, helping fund an army of 20,000 more staff to support GP practices as part of the NHS long-term plan.’ However, the spokesperson adds ‘we are also aware almost 9 out of 10 salaried GPs currently work part time’ – seeming to suggest the profession is partly to blame. NHS England has also announced an extension to its ‘Time for Care’ programme, introduced as part of the GP Forward View in 2016 to encourage new timesaving initiatives, such as social You could miss a result or misread a letter, or you don’t focus on the right symptom Professor Clare Gerada prescribing and digital consultations. It claims the programme has saved around £40m worth of GP appointment time and is extending it across the country. In the devolved nations, Scotland’s new contract has the GP as the lead in a multidisciplinary team; in Wales, the Government says a potential new contract will look at ‘how we can reduce GP workload’. And in Northern Ireland, GP practices last year started to receive some of a multimillion pound investment in practice-based staff, including physiotherapists, mental health specialists and social workers. Yet GPs are unconvinced by such measures. They warn that, for example, in England the creation of networks under the new GP contract could add to workload in the short-term with time needed to hire extra staff, set up the 30,000-50,000-patient networks and appoint a clinical director. ►