Dr Mary McCarthy: Changes needed to ease workload on GPs
I'm sure you've all heard friends or family talk about the difficulty of getting a GP appointment, but even I was shocked when the other evening a friend told me of a four to five week wait at her practice for a routine appointment with the doctor she is familiar with.
At my practice, although our energetic reception staff pride themselves on getting a same-day appointment for anyone who feels they need to be seen quickly, a routine appointment almost always involves a wait, especially if patients wish to see one particular GP.
The workload in general practice is heavier than ever before but there are fewer doctors choosing family medicine as a career and older GPs are retiring.
This is happening across the country, not just in Shropshire, and also, as I recently found out, in some European states as well. In countries like Ireland, their young doctors are emigrating to Australia, Canada and New Zealand, a trend that is beginning to happen here as well. In much of Europe they consider that general practice, as it is at the moment, is unsustainable so it was interesting to look at those nations where they consider family medicine is thriving.
These countries, about six out of 26 states, tend to have consultation times with their patients that are 20 to 30 minutes long, rather than the ten minutes we routinely allow. By and large they don't do house calls – patients who can't come to the surgery are assumed to be ill enough to be in hospital. They do, of course, have many more hospital beds.
This was interesting but the strongest factor that influenced a feel-good attitude seemed to be the number of patients that were seen in one day by one doctor. Those states that saw 20 patients or less in a day, say a maximum of 12 in a morning and of eight in an afternoon, managed better and kept their GP workforce. Those states that had 45-50 patient contacts a day found difficulty in recruiting new doctors and in retaining the ones they had.
It helped if time was built into the day for reflection and education and support by colleagues was valued.
The British Medical Association has repeatedly warned that GPs are currently experiencing a workload crisis.
To encourage young doctors into general practice, working conditions must at least be equivalent to those in hospitals where working hours come under the European Working Time Directive. They don't in general practice and the working day finishes when the job is done.
If we want general practice to be sustainable for the future we need to think of new ways of doing it.
