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Over-tired GPs will put patients' safety at risk - warning

Published 29/07/2015

The Royal College of General Practitioners says GPs in England had a 19% rise in consultations between 2009 and 2014 - an extra 61 patients each
The Royal College of General Practitioners says GPs in England had a 19% rise in consultations between 2009 and 2014 - an extra 61 patients each

Overworked GPs are becoming so tired they could be putting every patient's safety at risk, the head of British general practitioners has warned.

Increasing workloads - both during appointments with patients and after hours at the desk - are becoming so prevalent they could have a "negative and potentially disastrous impact" on doctors' ability to deliver safe and reliable care, the Royal College of General Practitioners (RCGP) says.

The body says hard-pressed GPs in England are dealing with a 19% rise in consultations between 2009 and 2014, an extra 61 patients each during that time, and additional demands being placed on their time to carry out administrative functions.

The RCGP has warned there is "considerable potential for patient harm, such as medication errors and mistaken patient identity, if GPs become persistently over-tired".

RCGP chairman Dr Maureen Baker said: "GPs will always work in the best interests of their patients - even when they are putting their own health at risk - but ironically this can actually have an adverse effect on patient safety.

"Few of us would voluntarily board a plane flown by a visibly-tired pilot or get on a train where we knew the driver had spent too much time at the controls, yet there are no methods or systems for addressing doctor and staff fatigue in general practice.

"Even in other areas of the NHS, 'distress signals' such as red and black alerts in hospitals exist so that other clinicians can simply declare that they cannot take on further work safely.

"But unless we disrupt patient services, which is the last thing that GPs want to do, we currently have no strategies in place to prevent and reduce the risk of patient harm that might arise from having tired overworked doctors and practice staff.

"With waiting times to see a GP now a matter of national concern, and patients in some areas of the country facing waits of up to a month to see their family doctor or practice nurse, our members are routinely working 11 and 12 hour days in surgery to try and accommodate.

"You might be able to do this for a short time, but when it becomes the norm, mistakes are going to be made.

"Fatigue among GPs is building up, to the detriment of their own health, and over time this could have a devastating impact on the care that our patients receive."

The comments, published in a RCGP report into working practices, comes after a government promise to recruit thousands more GPs and make surgeries open seven days a week.

Health Secretary Jeremy Hunt said he wanted to create flexibility for working patients and allow vulnerable people to have longer appointments. But it prompted an angry backlash from medics who said they were already working long and often anti-social hours.

The consultation paper launched by the RCGP will be sent to the Department of Health, NHS England, Care Quality Commission, General Medical Council and patient groups for their views in a bid to open up a debate about GP fatigue and burnout, and come up with solutions for tackling the problem.

Dr Baker said: "Our intention is not to panic patients but to send out a pre-emptive strike to ensure that we take steps now to protect patients from the risks arising from doctor and staff fatigue.

"Our workload is increasing but our workforce is reducing as thousands of family doctors approach retirement and insufficient numbers enter GP training to replace them, with the result that more family doctors are having to work unsafe hours to get the job done.

"The current GP workforce in England is approximately 3,300 too small, with this shortfall projected to grow to 8,000 by 2020 due to current changes in demographics and in the needs of our patients.

"GP fatigue is a clear and present danger to patient safety, and we urgently need to find workable solutions that will keep our patients safe now and in the future.

"The long-term solution is greater investment in general practice and more GPs. We must do everything we can to recruit, retain and return thousands more GPs to prevent hard-working and dedicated GPs being lost to patient care through ill health."

Shadow health secretary Andy Burnham told the BBC: "This is a very serious warning from the Royal College of GPs and it's not the first. They've been warning for some time now about a crisis in the profession, talking about practices just simply overloaded and people being burnt out by the workload.

"The Government hasn't taken it sufficiently seriously up to this point and they must start to because it will be patients, in the end, who pay the price."

A spokeswoman for the Department of Health said: "GPs do a fantastic job and we know they are under pressure as our population ages and more people live with long-term conditions.

"That's why we have committed to make 10,000 more staff available for general practice by 2020, including 5,000 more GPs. There's also lots of work being done to cut unnecessary paperwork.

"However real support for GPs will come through changing the way the NHS works to focus on prevention not cure, which we are doing by backing NHS England's five year plan. This will ease the pressures GPs face and create a better service for patients."

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