The BMA has just published its most recent quarterly tracker survey of doctors in the NHS, across the different branches of practice, including junior doctors, staff and associate specialists, consultants and GPs.
The findings once again demonstrate that, while there are pressures and stresses affecting the entire medical profession, the figures are far bleaker for GPs.
GPs continue to report the lowest levels of morale compared to other categories of doctors:
Average morale by branch of practice
(1= very low, 3 = moderate, 5= very high) the mean morale scores can be compared across branches of practice.
Consultants, SAS doctors and GPs’ morale is below moderate. The exception is junior doctors which is, at best, moderate.
GPs continue to report the lowest morale.
The number of GPs who find their workload unmanageable and unsustainable now stands at 73%, nearly twice the number compared to consultants, and a significant increase from the previous quarter.
Current workload by branch of practice
Junior doctors reporting their workload as being unmanageable or unsustainable has also increased this quarter (was 12.5 per cent, now 29.6 per cent).
GPs also remain the least satisfied with their work-life balance, and report the highest hours worked outside their regular working hours.
Working outside regular hours in the last month by branch of practice
Consistent with all previous editions of the Omnibus survey, this quarter confirms that GPs are most likely to report ‘always’ working outside their regular hours. All other branches of practice show a decrease since the last quarter in those “always” reporting working outside regular hours.
You can read the full set of results here.
I have sent these results to the health secretary Jeremy Hunt. They are far removed from the Government’s aspirations to increase the workforce by 5,000 GPs during the lifetime of this Parliament.
Fundamentally, unless GP workload is reduced to manageable levels and general practice once again becomes rewarding and attractive, doctors will continue to vote with their feet by choosing alternative medical career paths, or retire early.
I reiterated this message last week when I met the newly appointed health minister Alistair Burt, who has responsibility for general practice.
Mr Burt’s father is a retired GP, he therefore has a particular understanding of our job and has already publicly stated his support for general practice at this difficult time.
I urged the minister to translate his support into tangible measures to stabilise general practice, and work with us to reduce current workload pressures, if there is to be any reality to the Government’s pledge of increasing GP numbers.
Managing our workload – duty of care regarding chasing up investigation results
On the theme of workload, GPs nationally receive thousands of requests daily to follow up and act on investigations requested by other clinicians in hospitals and other sectors.
This is but one example of inappropriate workload being shifted on to GPs. These test results are by definition sent to the requesting clinician, whose responsibility it should be to take any action, unless he or she has agreed a transfer of that responsibility with the consent of the GP.
It is a waste of GPs’ time to incur the bureaucracy to retrieve results of tests ordered in hospitals, and it takes us away from caring for patients.
It also carries serious clinical governance risks of patient results being lost to follow-up, and in other cases can delay appropriate action. Such requests can also be easily missed, given they can be a sentence hidden in a long hospital letter.
As a result, I am pleased that the BMA GPs committee and the BMA consultants committee have published a joint statement on duty of care regarding communication of investigation results which is on the BMA website
It explicitly states that requesting GPs to chase up an investigation ordered in hospital is ‘potentially unsafe’, and that ‘the ultimate responsibility for ensuring that results are acted upon, rests with the person requesting the test’.
This advice is further in line with National Patient Safety Agency guidance and the Ionising Radiation (Medical Exposure) Regulations.
Practices should therefore refer such requests back to the requesting clinician, and to make it easier GPC has produced a model template in our toolkit Quality First – Managing Workload to Deliver Safe Patient Care document.
Additionally, practices should exercise their rights as members to require their CCG (clinical commissioning group) boards to use this joint statement to implement agreements with hospital providers to ensure that clinicians requesting an investigation follow up the result themselves, and do not shift this responsibility on to GPs. GPs should also inform their local medical committees of any such inappropriate requests. This will help facilitate a coordinated locality approach with CCGs and local providers.
NHS England £15m pilot of pharmacists working in GP practices
Last week NHS England launched a new £15m three-year pilot to fund, recruit and employ clinical pharmacists in GP practices.
The announcement is part of the GP workforce 10-point plan, and is the result of close collaborative work between NHS England, Health Education England, the GPC, the Royal College of GPs and the Royal Pharmaceutical Society.
These pharmacists will be working in about 250 practices, as part of the practice team seeing patients as well as carrying out tasks such as processing repeat prescriptions, which would otherwise be done by GPs, and with the aim of alleviating GP workload pressures.
At a time of significant GP recruitment difficulties, we have supported this pilot which we hope will develop systematic training for pharmacists to work in general practice, as well as evaluate their full potential in alleviating GP workload.
This scheme is of course by no means the answer to the pressures in general practice, but is part of a series of initiatives that we hope will ensure in the first instance that targeted practices get the sustained resources they need to safely manage their workload.
As always, you can keep in touch with the latest news on www.bma.org.uk/gpc
With best wishes
BMA GPs committee chair