By Eleanor Philpotts on the 22 December 2022 (GP Online Magazine)
Three in five GPs deliver more than the safe limit for patient contacts every day – and many routinely exceed it by double or more, a GPonline poll reveals.
BMA guidance on safe working in general practice defines the safe number of patient contacts per working day for a GP as 25 – although the limit is lower for more complex consultations.
However, GPs are routinely working far beyond this safety threshold as the overstretched primary care workforce tackles rising demand.
Of 455 GPs who responded to a GPonline poll, 60% said they delivered more than the 25-contact limit every day. A further 17% said they exceed the limit more than once a week – and just 9% said they never go over the safety limit.
Safe working limit
Around one in 12 GPs said the average number of patient contacts they delivered per day was more than double the 25-patient contact limit, and a further 21% reported between 40-50 daily contacts on average. A further 43% of respondents reported 30-40 patient contacts on average per day.
The findings come as pressures in primary care and across the whole NHS are coming into sharper focus – as the fortnight before Christmas saw strikes by ambulance workers and nurses, along with a surge in demand for GP appointments triggered by rising flu, COVID-19 and fears over strep A, while practices reported rising staff absences.
One GP responding to the poll said: ‘At the moment, I feel that it’s not safe at all. The workload is way too much and there is no staffing to cope safely.’
Another respondent added: ‘I’ve been off with burnout, having worked at a ridiculous pace over the last two years. Safe working is great, but in an environment where it can be delivered without impacting on patient wait times in primary care. Sessional timings (four hours) are irrelevant. Working 13 hours per day means that each session is 7.5 hours, not four.’
Other GPs responding to the poll reported concerns around low morale, fears that soaring pressure would lead to errors, and hopes that adopting advice on longer appointments could – in theory – bring some relief.
The BMA’s safe working guidance strongly recommends that practices take ‘immediate measures to move to 15-minute appointments’ – a move permitted by the GMS contract – although around a third of appointments already take longer than 15 minutes and one in five last more than 20 minutes.
One GP whose practice has moved to longer appointment slots said: ‘Our practice has 20-minute appointment slots for face-to-face and 10 minutes for phone/e-consults. It is total triage and has excellent same day access. The admin is what causes the high workload and frustration. I would happily see more patients if admin levels were down.’
Other respondents agreed that 15-minute slots per patient contact was safer and more efficient – but some respondents said they lacked the capacity to make the shift, with waits for routine appointments already long.
Some GPs have changed their appointments system on a short-term basis in direct response to current high levels of demand. Dr Irfan Malik, a partner in Nottingham, said on social media that his practice had moved to ‘urgent’ appointments only over the festive period to manage increased demand.
So how does that relate to Grimethorpe surgery?
Our GPs have 10-15 minute appointment slots. On Monday, because of increased demand, the slots are only 10 minutes long to create more capacity.
The doctors see around 16 patients per morning, and another 16 in the afternoon. That means a total of 32 appointments per doctor per full day of work. And that doesn’t even include the home visits yet.
And, indeed, we still don’t have enough appointments. Still, it is important to keep as close as possible to the ‘safe’ limits of 25 or less a day. Tired doctors (physically or mentally) are at an increased risk of making mistakes. And in medicine, making a mistake can mean the difference between life and death.
So, please consider that when you feel you really need to see the doctor that day. Do you really want to see a doctor who’s pushed to the limit and too tired to give you the care you deserve? Or would you rather wait a little bit longer or use another service like i-Heart or NHS 111?
“It will only take two minutes.”
“The doctor has a duty of care.” (yes, and that includes saying no when it’s not safe to say yes)
“I’m not leaving until the doctor sees me.”
“I have a right to be seen when I want, by the person I want to see.”
“I know my rights.”
“You have six doctors, an advanced nurse practitioner, and a physician associate. Surely someone can see me? You owe it to me.”
Those are just a few of the comments we receive on a regular basis from patients who believe they have a right to see the doctor when they want, where they want, and at the exact time they want. However, once the daily appointments reach capacity, we can’t simply create more. Not without putting our doctors, and patients at risk. Do you really want to see a doctor who is mentally exhausted after seeing lots of patients already?
“Well, just get some more doctors then.”
It’s not that simple. Doctors are hard to come by. And even if they weren’t, we would have a massive problem. We already struggle with the space we have available and simply couldn’t add any further staff as we haven’t got the rooms to put them in.
“You should have closed your list. Why do you still accept new patients?”
We asked if we could close our list. However, we were informed that any such request would be declined because of the needs of the community. So, we are stuck with a list that is growing, while we can’t increase the space we work from to increase the workforce. We’re, as they say, caught between a rock and a hard place. But, we are still determined to provide the best possible care we can.
And with that thought, we would like to wish all our patients and their loved ones a very happy Christmas and a happy and healthy 2023!