Rethinking GP workload beyond consultation hours

Weekly face-to-face sessions are only one aspect of a GP’s duties

Read more by Dr Lucia Gannon at www.mindo.ie

@LuciaGannon

The most frequent and annoying question that I have been asked throughout my career has to be, “Are you full-time or part-time?” (Nowadays, it is more likely to be, “Are you still doing a bit?”, but that is a topic for another day.) And often this question has been asked by people who should know better. People like me, who do a set number of face-to-face consulting sessions every week, but who also spend innumerable undocumented hours doing various other GP-related tasks.

When GPs explain their workload in terms of the number of face-to-face sessions completed weekly, they are grossly under-representing their work commitment. A prospective study of real-time work practices in Ireland by Crosbie et al, in the British Journal of General Practice (2020), reported that GPs work on average almost 10 hours per day. Six of these hours involve face-to-face consultations. The remainder of the time is made up of clinical paperwork, non-clinical administration, telephone consultations (both clinical and non-clinical), repeat prescriptions, educational activity, and house calls.

In general, a session is classified as any period equal to, or greater than, three hours of GP-related activity. From this study it was evident that a three-hour face-to-face session generated one and a half hours of non-face-to-face GP activity. So even a three-day work week for a GP equates to almost 30 hours.

The main reason this has been on my mind recently is that I was asked by a soon-to-be qualified GP how many sessions a week I thought would be a reasonable commitment. This doctor had heard more experienced GPs bemoan the fact that new GPs only wanted to work part-time. That they were not interested in partnership or owning their own business, and that this was detrimental to general practice. I have also heard this argument repeated for many years. Generally, reserved for female GPs, it also applies to males.

In the above study a GP working ‘full-time’, completing 10 sessions a week, would work an average of 50 hours a week. This is not sustainable long-term for any doctor and will quickly lead to burnout. While consulting is undoubtedly the most demanding work for a GP, the increasing amount of other GP-related activity requires a significant amount of concentration and expertise. Checking blood results, hospital discharge reports, updating medical records, writing referral letters, calculating QRisk scores, FRAX scores, and applying the relevant guidelines is not simply ‘paperwork’, that can be done while listening to your favourite radio programme or podcast. It is a significant cognitive load that often goes unnoticed, and unappreciated, even by those who do it, and is treated like an addendum to the real work of general practice, which is consulting. Over the years, the amount and complexity of this work has increased significantly with the transfer of work and responsibility from secondary to primary care and the increased access to diagnostics which brings with it the additional tasks of interpreting results and deciding what to do about them.

In the above study, a sizable proportion of non-consultation activities took place before 9am, after 5pm, and at weekends, with GP partners being responsible for most of this work. In addition, GP partners were responsible for maintaining the practice premises, employee welfare, upgrading and maintenance of computers, telephones, on-call arrangements, etc. Much of this work also took place outside of normal working hours. Nowadays, many GPs use social media platforms such as WhatsApp or Telegram as resources for real-time clinical information. These platforms are often active late into the evening and at weekends. This type of activity was not recorded in the above study, but many doctors regard them as informal learning networks that help them to provide the best medical care for patients.

My considered response to the young GP’s enquiry was not to think in terms of full-time or part-time work, but to consider how much time they can realistically devote to work to maintain a work-life balance. While face-to-face consulting is the core work of general practice it is all too easy to over-commit to this and then find oneself overwhelmed with non-consulting activity. A GP starting their career needs to be able to manage the amount of work that they must do on a weekly basis and to have enough time for family and additional interests. This is what makes us good doctors and allows us to appreciate the difference we make to people’s lives rather than feeling resentful or overwhelmed.

As experienced GPs, we owe it to our successors to be honest about the amount of work that we do. We need to say no to work that is not our responsibility, so as not to leave the legacy of an ever-increasing workload. And perhaps it is time to ditch the ‘full-time/part-time’ terminology.