A senior doctor in the United Kingdom has renewed calls for a cap on the number of daily consultations among general practitioners (GPs) to safeguard patient safety and the health of doctors.
Dr Laurence Buckman, a former chairman of the British Medical Association’s (BMA’s) General Practitioners’ Committee, argued that “the pressure to perform better and longer for more and more patients, with greater degrees of complexity, is now dangerous — for them and us.”
Writing in the BMJ, Buckman called on colleagues to support a recent campaign by the BMA to control GPs’ workload, arguing that “tired GPs risk harming patients — and themselves through stress associated illness.” He added: “I am not prepared to die for the NHS.”
The Burden of Bureaucracy
According to Buckman, bureaucracy is responsible for most of the pressure on GPs.
Similar concerns are experienced by doctors in the United States, who say they have to grapple with an administrative burden that affects patient access to healthcare.
“Studies have found that physicians spend only 27% of their time in direct clinical time with patients and 49% of their time on electronic health records and desk work,” said Dr Gary LeRoy, a member of the American Academy of Family Physicians (AAFP) board of directors.
“We’ve seen an effect on doctors’ well-being,” LeRoy told Medscape News UK. “Data indicate that more than half of family physicians reported they have felt burned out at some point.”
Buckman described a typical 12- to 14-hour day at his London practice. “Like many GPs we start out with a ‘fixed number’ of appointments — 18 surgery consultations in each half day — but we also have a policy to turn away nobody who says he or she is in need.
“We cope with this load. What crushes us is the bureaucracy (repeated referrals for the same problem, obstructive referral management systems, form filling, etc) not the (largely understandable) demand from patients. But, by the time I get home the compassion well has nearly run dry.”
Facing Up to a Recruitment and Retention Problem
In April this year, the BMA proposed a “cultural change” to control GPs’ workload in the face of shrinking resources. It said pressure on doctors had largely been brought about by the growth of complex multimorbidity among patients, a lack of long-term investment in general practice, and a recruitment and retention crisis. It called for an agreement on reasonable and safe workload limits.
A 2017 position paper from the American College of Physicians said that “the growing number of administrative tasks imposed on physicians, their practices, and their patients adds unnecessary costs to the US health care system, individual physician practices, and the patients themselves.”
According to Leroy, the AAFP is also contributing to reforms aimed at reducing paperwork and freeing up doctors’ time for patient care. It was also determined to address doctors’ well-being head on, he said. “We’ve developed a programme called ‘Physician Health First’ that’s designed to help family physicians understand the causes of burnout on a system-wide, individual practice, and personal level.
“The programme also provides tools for making changes that can reduce stress on both professional and personal levels.”
A Resource Issue?
Buckman said it was time to join a debate on capping patient access to general practice care. “We have to tell those who turn the tap that only so much water will go under the bridge today, for their safety and ours,” he wrote. “Politicians must also be honest with their voters — we have run out of doctors and time.”
Writing in the same “Head to Head” article in the BMJ, Dr Michael Griffiths, a GP partner in Caerphilly, Wales, rejected workload caps. A limit of 30 consultations a day, the equivalent of giving patients 12- to 13-minute appointments, would be “arbitrary,” he argued, and asked, “What happens if the 31st patient has chest pain, or is depressed, and leaves surgery so upset by our contractually enforced rejection that he or she attempts suicide.” He added: “Can we really turn them away and call ourselves professional?”
According to Griffiths, “What is needed is a greater proportion of NHS resource coming to primary care to enable us to administer our practices properly, allowing the right professional enough time to devote to each patient without feeling exhausted at the end of the day.”
No relevant financial relationships have been disclosed.
BMJ Published online May 8, 2018. Full text
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