Unrelenting and increasing workload pressures are pushing dedicated GPs to their limits and fatigue among overworked GPs could jeopardise patient safety on a widespread scale, the Royal College of General Practitioners has warned.
The RCGP has said that the GPs are hard pressed as they are not only working longer hours during the days on weekdays and are forced to work on weekends as well to cope up with essential and urgent paperwork, such as hospital referrals.
Unlike other professionals working in ‘safety critical’ industries, such as aviation or oil and gas industry, GPs can’t sound a ‘distress signal’ when they feel are overwhelmed or struggling with fatigue and this could lead to a negative and possibly disastrous impact on their ability to deliver safe patient care.
The RCGP adds that the unrelenting and increasing workload pressures are pushing dedicated GPs to their limits as they try to cope with rocketing patient numbers with diminishing resources and until urgent is taken to address this issue, there could be widespread patient safety concerns.
The College warns that the fatigue in GPs has potential for for patient harm – such as medication errors and mistaken patient identity.
In a consultation paper published today, the RCGP has put forward radical proposals for protecting the wellbeing of GPs and to prevent them becoming too exhausted to ensure that they provide safe care to their patients. Some of the radical moves include regular, mandatory breaks for staff to minimise the possibility of errors; mechanism to identify practices under extreme workload pressures – and for measures to be urgently implemented to relieve these pressures; full-scale review of how daily pressures in general practice can be reduced – including ways in which existing bureaucracy and unnecessary workload can be safely cut.
According to latest data, the number of people attending general practice is growing. There was a 19 per cent jump in the number of GP consultations from period between 2008/9 and 2013/14. In comparison, the number of GPs in UK grew by just 4.1 per cent during the same period translating in an additional 61 patients for each GP.
According to latest statistics, GPs and their teams are now seeing around 370m patients per year in England and general practice is managing 150,000 extra patients a day compared to 2008. The situation becomes more complicated when GPs have to examine patients that have multiple and chronic conditions. This becomes difficult with the standard 10-minute GP-patient consultation window and according to RCGP, in England alone, the number of patients with more than one long term condition was predicted to rise from 1.9 million in 2008 to 2.9 million in 2018.
At the same time, the share of the NHS budget that general practice receives has fallen consistently, year-on-year, to just over 8% in England – a record low.
The College claims that GP stress and fatigue is exacerbated by the growing burden of red tape and bureaucratic burdens, caused by form filling, box ticking and preparing for practice inspection visits by regulators the Care Quality Commission.
Recent College research estimated that an additional 120 hours per GP per year could be spent on frontline patient care by reducing unnecessary bureaucracy
In its ‘blueprint’ for the future of general practice published immediately after the General Election, the College called for a nationally-funded occupational health service to be established for general practice.
Its first-ever UK-wide campaign, Put patients first: Back general practice, calls for the share of the NHS budget for general practice to be increased to 11% – and for 10,000 more GPs across the UK over the next five years.
The consultation paper launched today will be sent to the Department of Health, NHS England, Care Quality Commission, General Medical Council and patient groups for their views in a bid to open up a debate about GP fatigue and burnout – and come up with solutions for tackling the problem.
RCGP Chair Dr Maureen Baker said: “GPs will always work in the best interests of their patients – even when they are putting their own health at risk – but ironically this can actually have an adverse effect on patient safety.
“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.
“Even in other areas of the NHS, ‘distress signals’ – such as red and black alerts in hospitals – exist so that other clinicians can simply declare that they cannot take on further work safely.
“But unless we disrupt patient services – which is the last thing that GPs want to do – we currently have no strategies in place to prevent and reduce the risk of patient harm that might arise from having tired overworked doctors and practice staff.
“With waiting times to see a GP now a matter of national concern, and patients in some areas of the country facing waits of up to a month to see their family doctor or practice nurse, 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.
“Fatigue among GPs is building up, to the detriment of their own health, and over time this could have a devastating impact on the care that our patients receive.”
She added: “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.
“Our workload is increasing but our workforce is reducing as thousands of family doctors approach retirement and insufficient numbers enter GP training to replace them, with the result that more family doctors are having to work unsafe hours to get the job done.
“The current GP workforce in England is approximately 3,300 too small, with this shortfall projected to grow to 8,000 by 2020 due to current changes in demographics and in the needs of our patients.
“GP fatigue is a clear and present danger to patient safety – and we urgently need to find workable solutions that will keep our patients safe now and in the future.
“The long-term solution is greater 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.”
