For most GPs, the greatest constraint to properly caring for our patients is the anachronistic 10-minute consultation, which nine in 10 GPs say cannot meet the needs of patients, both for an ageing population with multiple morbity, and also the transfer of care out of hospital.
A typical older patient with four chronic conditions would previously have occupied four outpatient clinics and taken up nearly one and a half hours, yet we are expected to do the impossible in 10 minutes. The intensity is compounded by GPs seeing far too many patients in a day – European averages are a maximum of 25 patients a day, yet in the UK, GPs can have upwards of 60 patient contacts daily. This short-changes patients and undermines quality and safety.
It is also professionally demoralising for GPs to be under constant pressure, racing against the clock, feeling unable to have the time to question, listen, examine, explain and do justice to the kernel of general practice that is the doctor-patient relationship. This unsustainable reality contributes to GPs quitting early, and puts off younger doctors from entering our profession.
Safe working in general practice
This is why our Urgent Prescription for General Practice campaign proposes to increase consultation times to 15 minutes or longer, while ensuring a safe workload limit for GPs so we can do our jobs properly and care for patients. This will increase job satisfaction and hopefully reverse the recruitment and retention crisis.
We of course really need thousands more GPs to increase capacity but given current workforce constraints the BMA GPs committee has published the new paper, Safe Working in General Practice. It proposes one way practices can work within limits. It proposes a model of ‘overflow’ urgent appointments, supported by locality hubs, which would be linked to local groups of practices. This is built on working examples of hubs in parts of England, referenced in our paper. We don’t suggest this is a panacea, and it may not be appropriate in some areas, but it is a practical approach that could suit some localities.
GPC will also work with NHS England to develop other approaches to enable GPs to have longer consultation times.
We welcome your views and comments on ways of increasing our consultation times and reducing the number of patients we see in a day to manageable levels. Please provide comments via the blog.
The release of our paper was accompanied by media coverage. The report appeared in The Guardian on 28 August, which was followed up with coverage in other national media outlets including a piece in The Daily Mail, broadcast reports on all BBC bulletins in the morning (including the Today programme, BBC News and major radio outlets), ITV and Sky News.
It is vital that our patients recognise and understand the impossible pressures we are under. Urgent Prescription will soon put forward proposals to work in partnership with patients to better manage demand on GP practices, together with our continued lobbying to Government for necessary greater resources.
With best wishes,
BMA GPs committee chair
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Focus on undated resignations and industrial action
I advised you last week that, after hard negotiations, NHS England has accepted GPC’s Urgent Prescription as a basis to take forward support for general practice, as was required by the local medical committees conference in May. Our proposals on longer consultations and workload limits will form an important part of our dialogue with the Government.
Although this means that balloting GPs on their willingness for industrial action and undated resignations is no longer necessary, GPC has spent the last three months considering the legal, practical and political implications involved in taking such action, to keep options open for future consideration if necessary.
We have produced Focus on Undated Resignations and Industrial Action, compiled by the BMA’s legal team, for GPs and practices. It highlights the complexities of undated resignations, with an explanation of the logistic and financial consequences, which would need to be fully understood should such action ever be considered.
With regards to industrial action, it is important to recognise the differences between independent contractor GPs and employees, such as hospital doctors:
− GP partners do not have the same (limited) immunities from the consequences of taking industrial action as employees do
− If a practice refuses to do something which is a contractual obligation, it could be served with a breach notice or have its contract terminated, irrespective of whether it is done as part of a campaign of industrial action. It is of note that more than a 100 breach notices were served on practices during the previous pension dispute, despite it having been BMA-coordinated action.
Our guidance also outlines action that can be taken which would not breach your contracts and as constructive measures to help you manage your workload to ensure safe patient care. More detail is included in the Focus on guide above, but broadly speaking, the types of action you could take include the withdrawal of services that are over and above contractual obligations. Such options may include:
− Increased used of external referral as a means of discharging the obligation to provide essential services
− Withdrawal of non-contractual services that GPs voluntarily provide
− Withdrawal from additional servces, such as the provision of contraceptive services
− Withdrawal from enhanced services, such as the provision of minor surgery, extended hours
− Withdrawal from the quality and outcomes framework
− Temporary suspension of new patient registration.
Junior doctor dispute
It is deeply regrettable that the Government has refused to negotiate with the BMA junior doctors committee, failing to acknowledge junior doctors’ concerns and continuing with its plan to impose the contract in October. We are supporting our junior doctor colleagues in calling on the Government to come back to the table to iron out and resolve the outstanding issues that form the basis of the dispute.