Following the recent King’s Fund report on the future GP workforce, and subsequent press pieces discussing the increasing number of “part time GPs,” maybe the time has come to consider how we define our working patterns, while also considering how they may be viewed from the public’s perspective.
The average working hours in the UK are currently 37 hours per week for a “full time” worker. Anything less than 37 hours is defined as “part time.”
GPs in the UK, use the same terminology, but the number of hours considered average is quite different. Assumptions around this has led to an outcry in the press, insinuating a few incorrect conclusions that need to be set straight.
GPs talk about sessions worked, and based on that are either full time or part time. Traditionally full timers work up to 10 sessions a week, with morning and afternoon sessions of clinical patient contact and home visits slotted in between. The majority of these sessions are now ram packed with high intensity clinical and emotional workloads. On top of this, we have optional extended hour sessions, out of hours sessions, and other commitments such as further clinical, managerial, or academic work.
What is not really taken on board is this hidden work. The work that is done in addition to clinical work. There are lots of hidden extra hours to get through, for example, the management of the practice, masses of clinical administration, clinical commissioning group work, audits, patient participation group work, teaching junior trainees, teaching students, mentoring staff, continuing professional development, reading emails, reading guidance, covering illness, and securing out of hours or sessional work. On top of this there are further processes to show you are able to do the job, i.e. appraisal preparation, CQC compliance, and so on.
What may often be overlooked is that while a GP practice is not open, each patient still has access to a senior doctor’s clinical opinion, 24 hours a day, all year round, via out-of-hours working. This remains true, even following the 2004 GP contract, which removed the individual responsibility each practice used to have to provide out of hours care.
A couple of years ago I dropped my clinical commitment by one session in order to keep my own sanity, protect patients, and also protect myself from the very real risk of burning out. Despite reducing my hours, I still work significantly more hours a week than the average UK working week. But, the result is that I have kept working. Many others have left the profession or left their practices to become sessional GPs. Others have switched to other roles, and some have decided to leave the country. Many of my colleagues have retired as soon as they were able to.
I don’t blame them, and I’m sure that most doctors seriously consider all of the options, just to escape the pressures placed on primary and secondary care at present. It is no surprise that juniors doctors must be considering the same.
Press articles have suggested that the “blame” for more part time GPs lies with female GPs. I take issue with this. GP’s considered to be working “part time” are still working longer than UK average working hours, while potentially juggling childcare and other responsibilities.
From my experience, part time and sessional GPs often put in longer hours than contracted GPs. Often far more than the comparable amount by a pro rata full timer.
Part time GPs aren’t the root cause of the exodus, but we need to consider how it looks from the public’s perspective. Perhaps the time has come to adopt a sporting analogy, and start calling our “part timers” what they really are—“full timers.” We could extend the analogy and start calling our “full timers,” what they really are, and that is “ extra timers.” Hopefully we can then avoid the shootouts.
Ian Morris is a partner at Leatside Surgery, Totnes, vice-chair Torbay LMC subcommittee, board member Devon LMC, and an academic tutor at Plymouth Peninsula Medical School.
This piece is written from a personal perspective, and the views expressed are my own.
Competing interests: None further declared.