GP workload reaching ‘saturation point’ warns medic
Alan McDevitt, head of Scotland’s GPs, said family doctors are increasingly being asked to take on more tasks without enough extra funding to employ staff to deal with the new work.
He said more doctors are needed to cope with the growing needs of patients in years to come, especially due to the ageing population and a move away from admitting people to hospital and caring for them at home.
The Clydebank GP also warned that ten-minute consultations are often too short to deal with the number of issues they are expected to cover to meet Scottish Government targets and collect statistics.
A British Medical Association (BMA) conference taking place next week includes a raft of motions calling for action to tackle the “overwhelming workload” now seen by Scotland’s GPs.
Last December, the BMA reached a deal with the Scottish Government for changes within the UK GP contract in efforts to address some issues with workload and protect funding, but which did not increase money going to practices.
Average GP pay in Scotland stands at around £89,000 – lower than elsewhere in the UK.
Dr McDevitt, chair of the BMA’s Scottish GPs committee, told The Scotsman that GPs are not looking for higher pay, but for the increased staff numbers now needed to do the job.
“The answer is that we need more GPs and more staff,” he said. “It is not about increasing GP pay because most of us would say if you give me more money I still can’t do it as there are not enough hours in the day.”
Dr McDevitt said general practice had changed a lot in recent years compared to the days when “you saw sick people, you did something with them and they went away”. GPs now manage several conditions which would previously have been dealt with in hospitals, such as thyroid disease and diabetes.
The ageing population means they are also dealing with growing numbers of patients with complex, long-term conditions who need regular care.
And the move to keep more people out of hospital and cared for in their own home – a measure supported by doctors – has also meant GPs have to be more involved in looking after them.
“As we get a more elderly population, many of them are going to have to be managed at home, both because that is the right place for them, but also to avoid expensive hospital admissions that might not be good for their health,” he said.
“We are trying to change the priorities of what we do as the population gets older. But how do we fit that into a day that is already stacked with thousands and thousands of decisions and communications and issues? That is the saturation issue. The GPs can’t really fit anything else in their day.”
Dr McDevitt said doctors also had to do more tests on patients which would previously have been done in hospitals, as well as chasing up results and explaining them to patients. And GPs also have to carry out work to try to prevent ill health.
To fit in all their work, many GPs are already working through breaks, late into the evening and on days off, Dr McDevitt said. He said this had led to a growing number deciding to limit their hours to cope.
“There is a massive trend now to moving to part-time. Most people would accept that full-time general practice is now too hard. There is a very high chance of burn-out,” he said.
“If you do full-time in general practice you are going to have a very difficult life and be very stressed. People just want to get away from that intensity.”
Health secretary Alex Neil said: “The GP contract agreed in December will reduce red tape. However, I am aware of concerns raised by GPs around workload and recognise that GP practices are dealing with a high workload – that is why their input to the current National Primary Care Workforce Survey is so crucial.
“The survey will help us establish a clear picture of our primary care needs around the clock and across the country, ensuring the right number of people are trained to the right level, further improving outcomes for patients.”
Case Study: ‘I worked every weekend for three months and ended up really unwell’
Amy Small has only been a GP since 2008, but the job has already taken its toll.
The 32-year-old, who works at Prestonpans Health Centre, decided to go part-time at the start of the year, as the long hours and heavy workload had started to affect her health.
Dr Small’s day starts at 8am, seeing 16 patients in the morning and 16 in the afternoon. In between these consultations, she has to deal with mountains of paperwork, ring-back patients wanting advice and sign a pile of prescriptions that all need to be checked.
The practice has seen a rising number of patients as new housing has been built.
“Unfortunately, the money that comes with patients is not equivalent to a new doctor,” Dr Small said. “How do you fit them in? You just do more, but everyone is getting tired.”
Dr Small said she tried to have a 15-minute break for lunch and sometimes she would have to attend practice meetings before starting afternoon surgery. She would normally not leave the practice until 7pm.
A major factor increasing their workload was changes to benefits which meant people with medical conditions needed to be reassessed, the GP said.
“The number of people who have been thrown off benefits is astronomical and the workload for us has just been ridiculous,” she said.
Dr Small said the drive to treat more patients at home was welcomed, but added to the work GPs were doing.
“We would all love to keep our patients at home and not send them to hospital, but the resources need to come with it. Nothing is being shifted from secondary care to primary care,” she said.
“There is a constant increase in workload and what we’re expected to manage, but nothing is coming with it.”
Dr Small said her work started to affect her health in the run-up to her wedding.
“I worked every weekend for three months and ended up really unwell. For me, that was a wake-up call that you need to change the way you are doing things.”
At Christmas, Dr Small decided to reduce her hours for the good of her health. She now works three days a week.
“I don’t physically see how people can continue to work full-time at this pace. Too many people are going to burn out,” she said.