Problems in primary care not confined to Ireland

Dr Muiris Houston highlights a new survey of GPs in the UK, which will resonate with those practising in Ireland

I remember seeing far too many patients in my first GMS job. I was given the use of a room in the local health centre but I had to vacate it by 11am. It meant seeing up to 25 patients in a little over two hours. Unsurprisingly, I emerged totally wrung-out, having concentrated so hard and worked so fast. It simply wasn’t sustainable and eventually it became a triage session, with follow-up appointments made for my own practice premises later in the day. It was far from ideal, unsafe for patients and ultra stressful for the doctor.

A GP workload survey has revealed the stark reality of what it means to be a general practitioner in the UK in 2019. Many of the findings will resonate with Irish GPs and suggest that my 1990s experience has come back to haunt us.

In the latest alarm-bell for general practice, a survey of some 1,700 GPs by the medical magazine Pulse found their average working day was 11 hours. This included eight hours of clinical care. And GPs working full time have an average 41 patient contacts a day — far higher than the widely accepted safe limit of 30.

Describing NHS GPs as being at their wits’ end, one doctor said: “GPs currently are making themselves ill in this job, and it isn’t sustainable. Often, they are left with no choice but to cut their sessions, retire early or leave the profession. No job should be at the expense of someone’s mental health, family or life. No job is worth that.”

Prof Helen Stokes-Lampard, Chair of the Royal College of General Practitioners (RCGP), described a 12-hour day with 100 patient contacts.

Over a half of respondents said they did not feel they were working at a safe level on the day of the survey. One-in-10 reported an astounding 60 or more contacts a day. Some 29 per cent of consultations were rated were “very complex” and 37 per cent “fairly complex”.

Echoing my own early practice experience, Prof Clare Gerada, former RCGP chair and an expert on GP burnout, said: “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.”

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.”

Nottingham GP Dr Jonathan Harte, who took part in Pulse’s survey, said he felt the risks to patient safety grow throughout the day. “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.”

While there is a substantial variation across Europe, about 25 consultations a day is a common level of activity, according to surveys of European doctors. In some countries, workload is controlled by list size, with GPs limited to 1,000 registered patients.

The reasons for the unsafe conditions are well known by now. We don’t have enough GPs, with doctor numbers falling consistently. A recent report estimated the NHS will have 7,000 fewer full-time equivalent GPs than needed within five years. And despite the manpower crisis, governments pile on the work for primary care. There is an unremitting decanting of services from the hospital sector but with no increase in resources. All while patients seek more from GPs within already-squeezed consultations.

Can the new GP contract help resolve these issues? We will have to wait and see. But part of the deal and one highlighted by Government is to extend free GP care, meaning more work, albeit under a separate contract.

Is it time for industrial action in order to secure more time with patients and make the consultation safer? In November in Spain, when workload became unmanageable, Catalonian GPs took to the streets of Barcelona, demanding a cap of 28 patient consults a day. Mind you, their demand for minimum 12-minute appointments sounds unambitious and unlikely to make things safer.

* I’m sure I’m not the only doctor to roll my eyes in despair at the recent revelations about the NAGP in a Sunday newspaper. What is it about doctors’ organisations? The IMO’s financial difficulties are still fresh in people’s memories and yet it seems to be a case of ‘here we go again’. Perplexing.