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Exhausted GPs put patient safety at risk

Overworked GPs may be threatening the health of patients on a ‘widespread scale’, according to the Royal College of General Practitioners (RCGP).

Healthcare professionals in primary care struggling with fatigue cannot “sound a distress signal” – such as red and black alerts in hospitals – when they are feeling overwhelmed, which could prove “disastrous and devastating” to their ability to safely care for patients.

RCGP claim that “unrelenting and increasing workload pressures” due to increasing patient numbers and fading resources are pushing practitioners to their limits.

Some GPs are working longer days to see all their patients, perform hours of surgery and try to keep up-to-date with urgent paperwork at weekends.

The college warns that despite risks being “inherently lower” in general practice than in hospitals, there is still “considerable potential for patient harm” such as prescribing the wrong medication or misidentifying patients due to over-tiredness.

RCGP chair, Dr Maureen Baker, said: “Few of us would voluntarily board a plane flown by a visibly tired pilot or get on a train where we knew the driver had spent too much time at the controls – yet there are no methods or systems for addressing doctor and staff fatigue in general practice.

“Our members are routinely working 11 and 12-hour days in surgery to try and accommodate. You might be able to do this for a short time, but when it becomes the norm, mistakes are going to be made. Our intention is not to panic patients but to send out a pre-emptive strike to ensure that we take steps now to protect patients from the risks arising from doctor and staff fatigue.

“The long-term solution is great investment in general practice and more GPs. We must do everything we can to ‘recruit retain and return’ thousands more GPs to prevent hardworking and dedicated GPs being lost to patient care through ill health.”

The college says the number of GP consultations rose by 19% in England between 2008 and 2013, yet the number of GPs across the UK just grew by 4.1% in the same timeframe. This means that each GP is now responsible for a further 61 patients. General practice is also managing an additional 150,000 patients a day compared to 2008.

Thousands of family doctors are also approaching retirement with insufficient numbers of GPs to replace them, causing family doctors to work unsafe hours and 11 to 12-hour days in surgery. The GP workforce in England has a current deficit of 3,300 practitioners estimated to fall to 8,000 by 2020 due to demographic changes.

The number of patients with more complex, multiple and chronic conditions have also increased which proves particularly complicated to deal with in standard 10-minute GP consultations.

Despite increasing pressures the share of NHS budget that general practice receives has fallen to an all-time low of just over 8% in England.

Due to these issues waiting times to see GPs are now a matter of ‘national concern’ with some patients having to wait a month to see a family doctor or practice nurse. 

In a bid to amend this issue the RCPG published a consultation paper today (29 July) making ‘radical’ proposals for guaranteeing their wellbeing and prevent exhaustion.

Proposals include mandatory staff breaks, measures to relieve extreme workload pressures and a full-scale review of how to reduce daily pressures such as through cuts to existing bureaucracy.

Time-consuming bureaucracy that can exacerbate stress is routinely caused by excessive form filling, box ticking and preparing for practice inspection visits by regulators. RCGP estimated that reducing superfluous bureaucracy could add provide each GP with an extra 120 hours a year to spend on frontline patient care.

The paper will be sent to the Department of Health, NHS England, CQC, General Medical Council and patient groups for feedback in order to start a debate about GP ‘burnout’ and draft solutions for tackling the wider problems.