The majority of GPs are seeing patients over and above the “safe level” on a daily basis, a new survey suggests.
Some 60% of family doctors say they see an average of 26-40 patients every day, according to a new survey by GP publication Pulse.
A new poll of 860 GPs from across the UK found that the average number of patients GPs are in contact with over a normal working day is 37.
The British Medical Association (BMA) and the European Union of General Practitioners recommend that GPs should not see more than 25 patients each day in order to deliver “safe care”.
A 2018 report from the organisations states that there is little research on safe levels of working, but there is evidence around doctor fatigue and an increase in errors or mistakes.
Meanwhile four in 10 (40%) of 408 GP partners surveyed said that their surgery had implemented a maximum number of consultations a GP can undertake each day, meaning 60% have no limit on the number of patients they could be asked to see.
The average number of patients per single GP continues to rise with some family doctors now responsible for more than 2,500 and this is not sustainable or safe— Professor Kamila Hawthorne
Pulse reported that many of those which had implemented a cap cited the need to operate within safe limits, and some also emphasised that any cap is flexible based on clinical judgement.
A GP partner in North East London, whose practice has introduced a daily limit of 25 patients per doctor, told Pulse that general practice is seen as a “limitless resource”.
“The thing we need to emphasise is that this is not about sloth, this is not about keeping things under control – it’s about keeping things safe. That’s why we do it,” said the doctor, who chose to remain anonymous.
“You need to be 100% sharp, you need to be picking up on cues, you need to be very, very alert, and safe in that.”
One GP told the magazine that his practice does not implement a limit “rigidly” because every patient contact is different.
“Twenty sore throats are not the same as 20 palliative care home visits for example,” said Dr David Coleman, a GP partner in Doncaster.
“We make a judgement about clinical capacity and use care navigation and triage to ensure we operate within our safe limits.”
Commenting on the survey, Professor Kamila Hawthorne, chair of the Royal College of GPs, said: “No two appointments in general practice are the same and patient contact numbers will vary depending on which clinical healthcare staff member is seeing the patient, practice and patient circumstances, and clinical judgement.
“Practices will manage this in the best way they can, based on their knowledge of their local patient population.
“However, there comes a point where demand exceeds capacity and GPs can no longer guarantee safe care to their patients, so we urgently need to find a range of solutions to this.
“GPs and their teams are working harder than ever to deliver safe, timely and appropriate care for patients.
“We are delivering millions more appointments than before the pandemic, with almost half offered on the day of booking but with 970 fewer fully qualified, full-time equivalent GPs than we did in 2019.
“The average number of patients per single GP continues to rise with some family doctors now responsible for more than 2,500 and this is not sustainable or safe.
“These pressures cannot continue to mount. GPs need to be able to practice safely and effectively, in the best interests of their patients and in the best interests of their own health to avoid burnout.
“That’s why we need to see the promises in the NHS Workforce Plan delivered.
“The plan pledges to train more medical students and outlines plans to increase capacity in GP training.
“But more GPs are leaving the profession than entering it right now, so an urgent focus on retention schemes for GPs is imperative, we can’t wait much longer.”
Dr Samira Anane, deputy chair of BMA’s general practitioners committee for England, said: “While the sample size of this survey is small, the findings paint an alarming picture on the capacity of GPs across the country.
“The BMA’s safe working in general practice guidance recommends that GPs don’t have more than 25 contacts per day, to ensure that patients are provided with high quality care to address their full range of needs. This helps to reduce the likelihood of repeat consultations and supports continuity of care.
“Practices have been seeing more patients than before the Covid-19 pandemic, against the backdrop of a shrinking workforce, with general practice being forced to work increasingly harder to keep patients safe.
“Practices are able signpost patients to 111, pharmacy services or self-referral schemes if it is the right thing for the patient.
“But with GPs continuing to leave the NHS in their droves at a time of unprecedented pressures and workload, we desperately need to find a long-term solution that helps to ensure patients aren’t the ones to suffer.
“If we’re serious about improving access to general practice, we need the help of the Government to address the huge shortfall in GPs, so we can keep up with the growing demand.”
A Department of Health and Social Care spokesperson said the poll is “misleading”.
They added: “The survey used a small sample and fewer than 3% of all general practices said that a maximum limit had been set.
“There are 10% more appointments available compared to before the pandemic and we have set an expectation that urgent appointments take place on the day they are booked.
“There are also more than 2,000 additional doctors in general practice compared to June 2019 and figures just released confirmed there are more than 31,000 additional staff working in general practice as well as a record number of trainees.”
