GPs are struggling to handle up to 90 appointments and consultations a day – more than triple the recommended safety limit.
General practices in England are carrying out more appointments than before the pandemic but are facing severe staff shortages. More than 1.45million patients waited at least 28 days to see a GP in September, according to the latest NHS figures.
GPs who spoke to the observer last week saying they are flouting the British Medical Association’s (BMA) guideline of “no more than 25 contacts per day” almost every day to ensure safe care. One doctor said he had more than 90 consultations in one day.
A conference of representatives from local medical committees in England this week will highlight the growing pressures on general medicine. Practices are being asked to more strictly limit the number of patient appointments for each GP.
One of the proposed motions presented to the conference by the Kensington and Chelsea local medical committee says “focusing on patient safety” is more appropriate than meeting high patient demand. It says the NHS should focus on “safe capacity”.
Such a move would mean longer wait times for doctor’s appointments, but doctors say it would help ensure patient care and the well-being of general practice staff.
The motion proposed for the London conference states that the “Conference considers general practice to be unsafe due to shortages of doctors and lack of investment”. Referring to the criticism the GP practice has received about patient wait times, he says that GP “scapegoats” are “completely unacceptable”.
dr Hussain Gandhi, GP at Wellspring Surgery in Nottingham, said he recorded 96 patient consultations in one day in April, of which about 20 patients were seen in person and the rest conducted over the phone. He said it was an “extraordinary day” but reflected the fact that GP surgeries were being stretched.
“The GP practice is on its knees and if nothing changes we will see it collapse,” he said. “There must be safe working boundaries for people who work in general medicine so that they can better serve patients.”
The Doctors’ Association UK, a campaigning organization for doctors, ran a social media campaign in October to draw attention to the increasing number of daily patient consultations by GPs.
dr Paul Evans, Gateshead GP and chairman of Gateshead and South Tyneside’s local medical committee, recorded 212 patient contacts in a single day last month and wrote: “Brain fried. Back in game tomorrow.”
Evans said he saw or spoke to about 60 of the patients and the other contacts were indirect and involved decisions or consultations about care. He said: “I would have said that every single decision I made was safe, but on a day like this I would probably guess you’d probably be better off being my first patient than my 200th.” A snapshot survey in March 2021 by pulse, the primary care magazine, revealed that GPs see an average of 37 patients per day. The BMA, the UK doctors’ union, last month updated its guidance on safe working practices in general medicine, recommending practices “take urgent action to move towards safe daily doctor visits”.
The Conservative Party pledged to supply more than 6,000 general practitioners, but there are concerns it will fall short of the target despite a significant increase in GP trainees. General practitioners warn of overcapacities and an urgent need for reform.
dr Richard Van Mellaerts, vice-chair of BMA England’s GP Committee, said: “GPs and practice staff work beyond safe limits and there is a limit to what they can safely do within the hours of the day.
“By limiting the number of consultations, those with less urgent needs will likely wait longer to be seen. However, the care provided at each appointment would be of better quality and reduce the need for repeat visits.” Prof Kamila Hawthorne, Chair of the Royal College of GPs, the professional body for general practitioners in the UK, said it was difficult to enforce a cap, as each patient had individual health needs, but new measures were needed to reduce the workload in primary care.
Hawthorne said: “It makes sense to put systems in place – similar to those that are already in place in hospitals – where sensible and temporary measures can be taken to reduce the pressure.”
The latest NHS figures show that there were an estimated 29.2 million general practice appointments in England in September, compared with an estimated 26.4 million in September 2019. Most appointments in September (68%) were made in person.
Over the same period from September 2019 to September 2022, the number of full-time equivalent, fully qualified general practitioners in England fell from 28,182 to 27,556. The number of general practitioners including trainees rose from 34,729 to 37,026 in the same period.
A spokesman for the Department of Health and Social Care said: “We remain committed to increasing the number of doctors in general practice. We provide 4,000 GP positions each year to create 50 million additional appointments per year.”