Calls for cap to limit GP workload amid safety fears

GPs will be driven "insane" without the introduction of a cap to limit workload, it has been warned.

Patient care will be compromised and the morale of doctors will plummet if they are made to take on more and more work, the British Medical Association (BMA) annual representative meeting heard.

Delegates at the conference in Brighton voted overwhelmingly in favour of a motion urging a "sensible cap is agreed on the workload of a GP which can be expected to be safely delivered in a day for the safety of patients and sanity of GPs".

Some doctors suggested that seeing 25 patients a day would be a "reasonable" limit.

The BMA said the motion did not set a precise figure or a timeline for introduction, adding that limits on workload "depend on the unique circumstances of each practice".

Dr Satish Narang, who proposed the motion, told delegates it was "insane to have an open-ended contract" for GPs.

He said: "If forced to take on more and more work without additional funding, workforce and resources, the consequence will be that the quality of work will be compromised, and unsafe in the case of patient care.

"It will drive the contractors insane, morale will become so poor that he will quit or become insolvent."

Gender pay gap
Gender pay gap

He added: "This is exactly what is happening to GPs."

Dr Narang, of BMA's Gwent and South Powys division, told the conference that GPs in Sweden are expected to see just 13 patients a day, with half-hourly appointments.

He warned "increasingly complex and intense consultations" cannot be managed within 10-minute slots.

"The day has limited hours and only so much can be managed without compromising the safety," he said.

"For the sake of quality and safety of patient care and the sanity of its troops, we urge the BMA to take a fresh approach by defining and agreeing what is a safe workload."

Dr Sridhar Sampalli, from BMA's Salisbury division, told the conference some GPs are reportedly seeing more than 70 patients "on exceptional days", while the safe standard in other countries is 25.

Dr Mary McCarthy, speaking in favour of the motion, said seeing 25 patients daily was "a reasonable amount of work to do".

"I think this should be viewed like a speed limit, and I speak as someone with points on their licence," she said.

"That there are occasions when you do break it, that there are obviously flu epidemics or a busy day in which you do see more.

"But that you do recognise that you're working at an unsafe level, other countries recognise this."

However Dr Gary Marlowe, chair of London regional BMA division, warned an arbitrary cap would "tie my hands to the detriment of my patients".

"In virtually every one of my sessions, there is a patient with a serious medical problem that would be impossible to identify without that consultation," he said.

"That patient could be the first appointment of the day, or the 26th appointment.

NHS backlog
NHS backlog

"Should we choose a cap of say 25, as has been suggested, what happens to that 26th patient?"

A spokesman for the BMA said: "GPs are in favour of a sensible workload to ensure they deliver the best care to their patients and do not put their own health and welfare at even greater risk.

"Today's Motion does not define the number of consultations, or a timeframe or scale for any capping.

"Appropriate limits on workload will depend on the unique circumstances of each practice and the preferences of each individual GP, as well as the complexity of their patients' needs and the type of consultation being provided.

"As we outlined in our GP workload strategy paper in March of this year, it is imperative that we spell out what's safe and what's sustainable so that practices can put in place systems and processes to support and rebuild general practice for the sake of both doctors and their patients."

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