GPs are struggling to cope with as many as 90 appointments and consultations a day – more than three times a recommended safety limit.
General practices in England are carrying out more appointments than before the pandemic but face severe workforce shortages. More than 1.45 million patients waited at least 28 days to see a GP in September, according to the most recent NHS figures.
GPs who spoke to the Observer last week say that almost every day they breach the British Medical Association (BMA) guideline of “not more than 25 contacts per day” to deliver safe care. One doctor said he had more than 90 consultations on one day.
A conference of local medical committee representatives in England this week will highlight the growing pressures faced in general practice. Surgeries are being urged to impose stricter caps on the number of patient appointments for each GP.
One of the proposed motions submitted to the conference by Kensington and Chelsea local medical committee says “focusing on patient safety” is more appropriate than meeting high patient demand. It says the NHS should focus on “safe capacity”.
Such a move would mean longer waits for GP appointments, but doctors say it would help safeguard patient care and the welfare of staff in general practice.
The proposed motion for the conference in London states that the “conference believes general practice is unsafe due to a shortage of doctors and a lack of investment”. It refers to criticism that general practice has faced over patient waiting times, saying the “scapegoating” of GPs is “entirely unacceptable”.
Dr Hussain Gandhi, a GP at Wellspring surgery in Nottingham, said on one day in April he recorded 96 patient consultations, with about 20 patients seen in person and the rest conducted by telephone. He said it was an “exceptional day” but reflected the fact that general practices were overburdened.
“General practice is on its knees and if something doesn’t change, we will see it break,” he said. “There need to be safe working limits for people working in general practice so they can give a better service to patients.”
The Doctors’ Association UK, a campaigning organisation for doctors, conducted a social media campaign in October to highlight the rising number of daily patient consultations faced by GPs.
Dr Paul Evans, a GP in Gateshead and chair of Gateshead and South Tyneside local medical committee, recorded 212 patient contacts on a single day last month, writing: “Brain fried. Back in the game tomorrow.”
Evans said he had seen or spoken to about 60 of the patients and the other contacts were indirect, involving decisions or consultations about care. He said: “I would have said every single decision I made was safe, but on a day like that I would probably suspect that you are probably better off being my first patient than my 200th.” A snapshot survey in March 2021 by Pulse, the magazine for primary care, revealed GPs were dealing with an average of 37 patients a day. The BMA, the trade union for doctors in the UK, updated its guidance for safe working in general practice last month, recommending practices take “urgent action to move towards safe consultation numbers per day”.
The Conservative party pledged it would deliver more than 6,000 GPs for general practice, but there are concerns it will miss the target despite a significant increase in trainee GPs. Doctors in general practice warn the service is at overcapacity and requires urgent reform.
Dr Richard Van Mellaerts, BMA England GP committee deputy chair, said: “GPs and practice staff are working beyond safe limits, and there is a limit to what they can safely provide within the hours of the day.
“By limiting the number of consultations, those with less urgent needs are likely to wait longer to be seen. However, the care provided in each appointment would be better quality and reduce the need for repeat visits.”Prof Kamila Hawthorne, chair of the Royal College of GPs, the professional body for general practitioners in the UK, said it would be difficult to impose a cap because each patient had individual healthcare needs, but new measures were required to help ease workloads in primary care.
Hawthorne said: “It does make sense to introduce systems – similar to those that already exist in hospitals – where sensible and temporary measures can be taken to ease the pressures.”
The latest NHS figures show there were an estimated 29.2m appointments in general practice in England in September, compared with an estimated 26.4m in September 2019. Most of the appointments in September (68%) were conducted in person.
Over the same period from September 2019 to September 2022, the number of full-time-equivalent, fully qualified GPs in England fell from 28,182 to 27,556. The number of all GPs over the same period, including trainees, rose from 34,729 to 37,026.
A Department of Health and Social Care spokesperson said: “We remain committed to increasing the number of doctors in general practice. We are making 4,000 training places available for GPs each year to help create an extra 50m appointments a year.”
