High stress and low satisfaction with workload among UK GPs.

Feeling the strain: what the Commonwealth Fund’s 2019 international survey of general practitioners means for the UK  | The Health Foundation 

This document presents UK-focused analysis of ‘The Commonwealth Fund’s 2019 International Health Policy Survey of Primary Care Doctors in 11 Countries’. This includes responses to several UK-specific questions funded by the Health Foundation.  The survey asked GPs’ views on their working lives, changes in how they deliver services and the quality of care they can provide to patients.

Key points
  • The Commonwealth Fund surveyed 13,200 primary care physicians across 11 countries between January and June 2019. This included 1,001 general practitioners (GPs) from the UK. The Health Foundation analysed the data and reports on the findings from a UK perspective.
  • In some aspects of care, the UK performs strongly and is an international leader. Almost all UK GPs surveyed use electronic medical records, and use of data to review and improve care is relatively high.
  • The survey also highlights areas of major concern for the NHS. Just 6% of UK GPs report feeling ‘extremely’ or ‘very satisfied’ with their workload – the lowest of any country surveyed. Only France has lower overall GP satisfaction with practising medicine. GPs in the UK also report high stress levels, and feel that the quality of care that they and the wider NHS can provide is declining.
  • A high proportion of surveyed UK GPs plan to quit or reduce their working hours in the near future. 49% of UK GP respondents plan to reduce their weekly clinical hours in the next 3 years (compared to 10% who plan to increase them).
  • UK GPs continue to report shorter appointment lengths than the majority of their international colleagues. Just 5% of UK GPs surveyed feel ‘extremely’ or ‘very satisfied’ with the amount of time they can spend with their patients, significantly lower than the satisfaction reported by GPs in the other 10 countries surveyed.
  • Workload pressures are growing across general practice, and UK GPs report that they are doing more of all types of patient consultations (including face-to-face, telephone triage and telephone consulting). Policymakers expect GPs to be offering video and email consultations to patients who want them in the near future, but the survey suggests that this is currently a long way from happening. Only 11% of UK GPs report that their surgeries provide care through video consultation.

See also: Health Foundation press release

£1.5 billion to deliver Government commitment for 50 million more general practice appointments

Government and NHS commit an additional £1.5 billion in total for general practice | Department of Health and Social Carestethoscope-1584223_1920

The Government and NHS England have committed at least an additional £1.5 billion for general practice over the next four years for additional staff, a key step towards delivering 50 million more appointments in general practice by 2024.

In addition to the Government’s commitment to invest in general practice under the Long Term Plan, this funding is for the recruitment of 6,000 more primary care professionals as well as for initiatives to support the recruitment and retention of doctors in general practice.

In agreement with the profession, the General Practice Contract for 2020/21 will also offer more check-ups for new mums as part of a major deal with England’s family doctors.

Also included in the agreement are regular visits for care home residents, assessing medication and new incentives to increase uptake of vaccinations and learning disability health checks, expand social prescribing referrals, and improve prescription safety checks.

Expanding the new workforce will allow GPs to focus on the sickest patients and will in time allow them to provide longer appointments to people who need one.

Full story at Department of Health and Social Care

Long waiting times for GP appointments are unacceptable, says RCGP. College calls on Government to prioritise general practice which has been ‘running on empty for too long’

Royal College of General Practice | January 2020 | Long waiting times for GP appointments are unacceptable, says RCGP. College calls on Government to prioritise general practice which has been ‘running on empty for too long’ 

Responding to a feature that ran in The Sunday Times (in last Sunday’s edition, 5 January 2019), Professor Martin Marshall, Chair of the Royal College of GPs, said: “It is totally unacceptable to expect patients to wait weeks for a GP appointment. Patients -and GPs – deserve better. 

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“However, the situation in which we find ourselves has not happened overnight, and the College has been sounding the alarm bells for many years.

Over 1m patients are seen in general practice every day, and GPs are doing their best but the service cannot keep stretching. There are limits beyond which GPs can no longer guarantee safe care to patients and the potential for error or misdiagnosis increases.

“There is also the risk that long waiting times for a GP appointment will deter some patients from seeing a GP at all, which could mean they seek help at a much later stage when the problem is much more serious.

“Pressure of workload is taking its toll on the health and wellbeing of GPs themselves. For too many, the job has become untenable, with the result that they are burning out and leaving the profession before their time.

“It is extremely encouraging that we have more GPs in training than ever before, but it takes a long time to qualify and we need urgent action to retain existing GPs and ensure they are supported to remain in the profession and that the job of a frontline GP becomes ‘do-able’ again.” (Source: RCGP)

Related:

The Times Eleven million patients wait more than three weeks to see GP

Story also reported in:

BBC News GP shortages cause ‘unacceptable’ patient waits

The state of medical education and practice in the UK

New publication from General Medical Council (GMC) reveals 45% of GPs work less than full time, and 36% have reduced their hours in the past year as report highlights doctors are making choices for a better work-life balance.

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Image source: https://www.gmc-uk.org/

This report highlights changing approaches to work-life balance and career development which impact on UK health services’ ability to plan for patient demand. Against a backdrop of rising workloads and the need to recruit and retain a sustainable medical workforce, the report finds doctors moving away from traditional career and training paths. Among notable trends is the rise in the number of doctors choosing to spend time working as a locum, practising medicine abroad, or even taking a year out, rather than going straight into specialty or GP training after the completion of their initial training.

Full report: The State Of Medical Education And Practice In The UK: 2019

See also: GMC press release: Doctors’ career choices a ‘new reality’ which health services cannot ignore

Electronic prescriptions to be rolled out across England from next month

NHS Digital | October 2019| Electronic prescriptions to be rolled out across England from next month

From November 2019 all prescriptions by GPs will be issued digitally as the final phase of the Electronic Prescription Service (EPS) is rolled out.

Under the new system, patients who have nominated a pharmacy will continue to have their prescriptions sent electronically. Those who do not have a nominated pharmacy will receive a paper copy of their prescription that will include a barcode, which pharmacy staff will scan to download the electronic prescription from the NHS Spine.

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The DHSC said that currently 70% of prescriptions are already prescribed electronically and following the roll-out almost all will be sent electronically. It estimated that the EPS will save the NHS £300m by 2021 by increasing efficiencies, reducing the amount of paper processing required and reducing prescribing errors.

NHS England added the new process will lead to a ‘more efficient, faster and secure service’ (Source: GP Online)

GP Online Electronic prescriptions to be rolled out across England from next month

In the news:

OnMedica Digital prescribing to go nationwide

The Guardian NHS to fully digitise prescriptions under plan to save £300m

 

GPs diagnosing cancers earlier

New study concludes that GPs appear to be diagnosing cancers earlier, helping to reduce the numbers of cancer patients receiving their diagnosis in accident and emergency (A&E) departments, thereby improving their chance of survival British Journal of General Practice | via OnMedica

In this large study, the researchers studied Routes to Diagnosis data on 554,621 patients with cancer in England who presented as emergencies between 2006 to 2015. They found there was a decline in the annual rate of emergency presentations, with emergency referrals from GPs falling by about a half.

The authors suggested this was likely to reflect increasing use by GPs of the two week wait referral pathways, as well as reductions in emergency presentations following a GP referral, likely indicating a trend towards earlier diagnosis in general practice.

Full story at OnMedica

Full article: Herbert A, Abel GA, Winters S, et al. | Cancer diagnoses after emergency GP referral or A&E attendance in England: determinants and time trends in Routes to Diagnosis data, 2006–2015 | British Journal of General Practice 2019

NIHR: Decision support tools can help GPs reduce antibiotic prescriptions for respiratory conditions

NIHR | May 2019 | Decision support tools can help GPs reduce antibiotic prescriptions for respiratory conditions

National Institute for Health Research (NIHR) funded a trial which has shown a 12% reduction in GP antibiotic rates for respiratory conditions through electronic decision and training tools. The Signal from NIHR indicates that there was a reduction in prescriptions for patients between 15 and 84 were but there was no observed difference in younger children and older adults.

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Read the full Signal from NIHR 

Gulliford, M. et al. 2019| Effectiveness and safety of electronically delivered prescribing feedback and decision support on antibiotic use for respiratory illness in primary care: REDUCE cluster randomised trial| BMJ |364 | doi: https://doi.org/10.1136/bmj.l236 

OBJECTIVES: To evaluate the effectiveness and safety at population scale of electronically delivered prescribing feedback and decision support interventions at reducing antibiotic prescribing for self limiting respiratory tract infections.

DESIGN: Open label, two arm, cluster randomised controlled trial.

SETTING: UK general practices in the Clinical Practice Research Datalink, randomised between 11 November 2015 and 9 August 2016, with final follow-up on 9 August 2017.

PARTICIPANTS: 79 general practices (582 675 patient years) randomised (1:1) to antimicrobial stewardship (AMS) intervention or usual care.

INTERVENTIONS: AMS intervention comprised a brief training webinar, automated monthly feedback reports of antibiotic prescribing, and electronic decision support tools to inform appropriate prescribing over 12 months. Intervention components were delivered electronically, supported by a local practice champion nominated for the trial.

MAIN OUTCOME MEASURES: Primary outcome was the rate of antibiotic prescriptions for respiratory tract infections from electronic health records. Serious bacterial complications were evaluated for safety. Analysis was by Poisson regression with general practice as a random effect, adjusting for covariates. Prespecified subgroup analyses by age group were reported.

RESULTS: The trial included 41 AMS practices (323 155 patient years) and 38 usual care practices (259 520 patient years). Unadjusted and adjusted rate ratios for antibiotic prescribing were 0.89, respectively, with prescribing rates of 98.7 per 1000 patient years for AMS (31 907 prescriptions) and 107.6 per 1000 patient years for usual care (27 923 prescriptions). Antibiotic prescribing was reduced most in adults aged 15-84 years, with one antibiotic prescription per year avoided for every 62 patients (95% confidence interval 40 to 200). There was no evidence of effect for children younger than 15 years or people aged 85 years and older; there was also no evidence of an increase in serious bacterial complications.

CONCLUSIONS: Electronically delivered interventions, integrated into practice workflow, result in moderate reductions of antibiotic prescribing for respiratory tract infections in adults, which are likely to be of importance for public health. Antibiotic prescribing to very young or old patients requires further evaluation.

The journal article is available from the BMJ 

RCGP Scotland: Calls for new GP recruitment target

Royal College of General Practitioners | June 2019 |Call for new GP recruitment target

Royal College of General Practitioners Scotland has called for new recruitment targets to be set to boost GP numbers in Scotland. Alongside this RCGP Scotland have launched a new campaign #RenewGP as well as 11% of the NHS budget being used to ensure GP practice in Scotland is ‘future for the future’. As part of this RCGP calls for a minimum 15 minute appointment per patient but recognises that this can only be achieved with more GPs in the system. 

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Image source: rcgp

The report explores what RCGP consider to be the most important issues facing the profession and patients, as well as makes a series of recommendations at the end of each chapter.

The report makes six key calls:

  • Provide time to care. GPs must be given the time they need to care for their patients. 10-minute appointments do not work for an increasing number of patients or GPs. Minimum 15-minute appointments as standard would enable patients to have more choice over their care, especially when they have multiple conditions. This would be achieved only by the introduction of more GPs into the system in Scotland.
  • Safeguard the future of the NHS in Scotland. We need a National Conversation, led jointly by politicians, healthcare professionals and patients, to promote sustainable use of the NHS and safeguard its future.
  • Tackle health inequalities. GPs serving areas with high socio-economic deprivation should be appropriately resourced to ensure that the NHS is at its best where patients need it most. This will be possible when 11% of the Scottish NHS budget is allocated to general practice.
  • Planning for the future workforce: As our population lives longer with more long-term conditions, Scotland needs more GP capacity to build and lead our community healthcare teams. In order to accurately assess and plan the workforce needs for Scotland’s future, the Scottish Government must collect figures and report on Whole Time Equivalent GPs, not simple headcount figures, so that workforce plans of the future are accurately and reliably informed.
  • Improve healthcare systems for the benefit of patients and GPs. Urgent investment in IT is required to ensure that systems work more effectively together, improving reliability for clinicians and patients.
  • Promote Scottish general practice to a new generation of doctors. Investment is required to enable 25% of the undergraduate medical school curriculum to be delivered in primary care

Full details from Royal College of General Practitioners

News release:

Royal College of General Practitioners Scotland’s GPs call for 11% of NHS funding to tackle health inequalities in communities

See also:

OnMedica Call for new GP recruitment target

 

Half of GPs working unsafe levels

More than half of GPs say they are working above safe limits, on average completing 11-hour days and dealing with a third more patients than they say they should be | story via Pulse

Full-time family doctors are on average dealing with 41 patients in a day – when GPs said the safe limit should be 30, according to Pulse’s survey of 1,681 UK GPs.

Some are seeing far higher numbers of patients – around one in ten deal with 60 patients or more in a day. Meanwhile, they reported the intensity of work was high, with GPs saying 29% of their patient contacts – a mixture of face-to-face, phone, online appointments and home visits – were ‘very complex’, and 37% were ‘fairly complex’.

Full detail at Pulse

GP leaders said the findings showed the profession ‘was working far beyond their capacity’ and warned the level of workload was affecting GPs’ own health and posing a risk to patient safety.

See also: The full story of how GP workload is jeopardising patient safety | Pulse

Number of GPs in the UK

The Nuffield Trust has carried out an analysis of the number of GPs in the UK   

Key points

  • Across the UK, the number of GPs relative to the size of the population has fallen in a sustained way for the first time since the 1960s.
  • The fall in number of GPs has been particularly marked in certain regions of England such as North West London and the East of England. These regions also have the lowest total number of GPs per 100,000 people, whereas Scotland has the highest.
  • The fall in GPs per person reflects insufficient numbers previously being trained and going on to join the NHS; failure to recruit enough from abroad; and more practitioners leaving for early retirement.

Full detail: Is the number of GPs falling across the UK?

The Nuffield Trust has also produced an explainer The NHS workforce in numbers.  This summary provides facts on health care staffing and highlights the extent of current shortages and their effect.

See also: GP pressure: Numbers show first sustained drop for 50 years | BBC