GPs ‘see more patients than is safe’
Family doctors say they are at risk of making mistakes due to increasing workloads.
GPs across the UK are seeing far more patients than they think is safe, with some openly making mistakes, according to new research.
The study, carried out by Pulse magazine, found that overtired doctors were sometimes seeing twice as many patients as they should and struggled to be sympathetic to those coming through the door.
Meanwhile, a separate analysis by the Nuffield Trust for the BBC found numbers of GPs per 100,000 people in the UK has fallen from nearly 65 in 2014 to 60 last year, the first sustained fall of this kind since the late 1960s.
The Pulse poll of 1,681 GPs for BBC’s Panorama found that they are working an average 11-hour day, including eight hours of clinical care and three hours of admin.
On average, each GP dealt with 41 patients per day, despite saying 30 was a safe number.
One in 10 dealt with 60 or more patients – double the safe limit.
When it came to the type of health issues patients had, GPs said 29% of cases were “very complex” and 37% were “fairly complex”.
The poll asked family doctors about their experiences on a single day – February 11 – when seven out of 10 of the GPs were scheduled to work six or more hours.
Just over half said their workload that day was beyond safe levels, but most said it represented a typical day.
The data included face-to-face contact with patients (the most common type), phone and online appointments and home visits.
Professor Helen Stokes-Lampard, chairwoman of the Royal College of GPs, is one of those affected by heavy workloads.
She said: “In my own practice recently, I had a 12-hour day and 100 patient contacts.
“GPs across the UK will tell similar stories.”
Nottingham GP Dr Jonathan Harte, who took part in the survey, told Pulse: “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.”
A Hertfordshire GP said: “There is a point where I feel cognitively drained; after about 20 patients, there is not an iota of empathy left.”
Dr James Howarth, a GP in Spilsby, Lincolnshire, said: “I was duty doctor on the day of Pulse’s survey, and I had 124 patient contacts.
“The median is about 60 to 70 – beyond a safe level.”
He said as well as patient demand, there was a “workload dump” from secondary hospital care, such as “decoding illegible handwritten prescription requests”, consultants sending patients back for referrals to their colleagues, chasing referrals for patients, chasing missing information and dealing with inadequate discharge letters.
He added: “This workload creates patient safety risks. There are risks around having multiple patient notes open because we’re helping a nurse out with hers, or we’re 30 minutes late so we see the next patient while finishing the notes of the last.
“We might forget consultant details, plans and actions, or prescribe for the wrong person, use the wrong labels on blood tests, and so on.”
He said in the previous week he sent a blood test using the wrong patient details due to being extremely busy.
“I spotted it in time, but how many do we fail to spot?,” he said.
“I have raised safety concerns with governing bodies before. I was basically told to shut up or my practice would be run over with a fine-toothed comb.”
Professor Clare Gerada, former chairwoman of the RCGP, said tired GPs were at risk of mistakes, and high numbers of patients added to this.
“You could miss a result or misread a letter, or you don’t focus on the right symptom or ask the right question,” she said.
A report in March from the King’s Fund, Nuffield Trust and Health Foundation predicted that GP shortages in England will almost triple to 7,000 by 2023/24.
It said the Government would miss its target to recruit 5,000 more GPs by 2020 and the only way to cope with the growing workload was to put more pharmacists and physiotherapists into GP practices.
Research from Europe suggests GPs see 25 or fewer patients per day.
Dr Nikita Kanani, NHS England’s national medical director for primary care, said: “We already know that general practice is under pressure which is why investment in local doctors and community services is increasing by £4.5 billion, helping fund an army of 20,000 more staff to support GP practices as part of the NHS Long Term Plan.
“But we are also aware that almost nine out of 10 salaried GPs currently work part-time.”
Nuffield Trust director of strategy Helen Buckingham said its analysis found 3,400 fewer GPs were working in the NHS than would be expected if numbers had kept up with population growth.
And she told BBC Radio 4’s Today programme: “Our calculation suggests that if we don’t do anything, that figure could increase to a gap of 7,000 within the next five years.
“We think there are a number of reasons. There was a decrease in training places and that’s been reversed. There are now more GPs going into training.
“But not all those who go into training stay in the NHS once they’ve qualified.
“In 2012 about one-third of GPs took early retirement. Now that’s about two-thirds, so that’s a very significant change.
“We think that’s related to some of the pressures GPs are experiencing but we also think it’s related to changes in the tax allowances and the constraints of the NHS pension scheme that have meant that it’s not affordable for GPs to stay in the system.”
Dr Richard Vautrey, chair of the British Medical Association’s GP Committee, told Today: “We have faced a crisis in general practice over the last decade, largely because of the workload pressures GPs have been facing.
“That’s become untenable. For younger doctors it’s put them off and for older doctors it’s hastened their retirement.
“That’s left us with more patients to see with fewer doctors and that’s added further pressure causing a vicious cycle.”