If no-one knows how much work is being done and the toll it takes, then it becomes impossible to define how much workload is safe for a GP to do
Numbers are useful. Before proper numbers perhaps primitive humans could count to ten, or show their fingers to represent those figures; anything larger was simply, “A lot”, or if they were destined to be junior doctors, “A lot+++”. The ability to define large numbers is actually highly relevant to patient safety.
Doctors, and perhaps GPs in particular, have always been pretty vocal about how hard they work; how much their workload is. When asked, “How hard do you have to work?” they answer, “A lot!” or if they are junior doctors, “A lot+++.”
But how much is “a lot” in this case? Have doctors simply run out of numbers to quantify how hard they work or do they not know? One thing that seems clear is that the workload of doctors is more than before. How much more? Well one can guess.
There are some measurements of the amount of work that doctors do. The numbers of patients that turn up or who are taken to Emergency Departments is counted. This number doesn’t necessarily directly correlate to workload, it just counts the numbers of patients; it doesn’t take into account their complexity, the staff skill mix present at the time, how dependent the patients are on having a member of staff with them, and so on. I imagine that someone working in resus could spend four hours with the same sick patient and have a higher workload than their colleague in minors dealing with “See and Treat” patients. But at least the numbers are being counted and could be used to guide staffing levels.
The same can’t be said, unfortunately, about general practice. Nobody, it seems, is counting the numbers for general practice in a systematic way. There have been a limited number of studies to show that there has been a rise in consultations, prescriptions, and correspondence dealt with in primary care. Some GP surgeries endeavour to collect this data, mainly to monitor whether the interventions that they are implementing are having any effect on workload.
But, in general, GPs work a lot. And they work a lot more than they used to. A lot+++, in fact. The barometer of workforce level tells us this, but no-one can quantify what isn’t being counted. And because no-one is counting it means we can’t even begin to talk about the impact on workload of increasingly multi-morbid patients we try to squeeze into 10 minute appointments, as well as dealing with complex prescriptions, discharge summaries, and clinic letters.
And if no-one knows how much work is actually being done and the toll it takes, then it becomes impossible to define how much workload is safe for a GP to do.
Samir Dawlatly is a GP partner at Jiggins Lane Medical Centre in Birmingham. The views expressed here are his own and don’t necessarily represent those of any organisation he works for.
Competing interests: I am a GP partner at Jiggins Lane Medical Centre, a partner of Our Health Partnership. I am an occasional member of the RCGP online working group on overdiagnosis.The views expressed here are my own and don’t necessarily represent those of any organisation I work for.