‘Cap GP appointments for safety’
THE number of appointments GPs take each day should be capped to ensure the welfare of both patients and doctors, a leading medic has warned.
Dr Laurence Buckman, former chairman of the British Medical Association’s (BMA) GP committee, said GPs risk harming patients due to the high numbers that come through the doors each day.
He added that a 10-minute consultation was “too short” for the amount of work required to meet patients’ increasingly complex needs.
Writing as part of a debate in the British Medical Journal (BMJ), he said: “The time has come when the public has to be told that it is unsafe for them to be seen when the GP is not thinking optimally, and that tired GPs risk harming patients and themselves through stress-associated illness.
“We must no longer squeeze what needs to be done for patients into 10 minutes. We must stop pretending that we can see potentially unlimited numbers of possibly sick people without respite.”
Dr Buckman said he typically starts his shift with a “fixed” number of appointments – usually 18 each half-day – but also had a policy of not turning away anyone in need.
But he confessed that he could not cope with this workload for much longer without becoming ill himself.
“I am not prepared to die for the NHS,” he said.
“My day as a principal is typically 12-14 hours long. I know, sadly, that I do not think as quickly or as laterally at the end of the evening as at the beginning of the day.
“What crushes us is the bureaucracy (repeated referrals for the same problem, obstructive referral management systems, form filling, etc.) not the (largely understandable) demand from patients.
“But by the time I get home the compassion well has nearly run dry.”
While he agreed a cap was needed, he said he did not want to open GPs up to more attacks about lack of availability.
“We must collectively tell patients that there are not enough of us, and there are too many of them,” he added.
“We have tried a host of manoeuvres to control demand (notices in surgeries, local and distant triage, trying to reduce NHS bureaucracy, etc) but they have not held back the flood.
“We have to tell those who turn the tap that only so much water will go under the bridge today, for their safety and ours.
“Politicians must also be honest with their voters – we have run out of doctors and time.”
A counter-argument in the debate came from Caerphilly GP Dr Michael Griffiths, who warned that capping GP appointments could limit flexibility, inhibit professionalism and cause harm in itself.
“Let’s set an arbitrary limit of 30 patient contacts in a working day,” he said.
“What happens if the 31st patient has chest pain, or is depressed, and leaves surgery so upset by our contractually enforced rejection that he or she attempts suicide?
“They may not announce themselves as an emergency. Can we really turn them away and call ourselves professional?”
Dr Griffiths claims that being contractually obliged to see a certain amount of patients could also be counter-productive.
“We are encouraged to employ other practitioners to manage minor illness, leaving only the more complex cases for the doctor,” he added.
“A morning of psychosocial problems – such as the patient who cannot pay the ‘bedroom tax’ and is threatened with eviction; the parent whose child is not performing as expected at school who wants an assessment for autism or attention deficit hyperactivity disorder; or the mother of five children who is being emotionally and physically abused – leaves me emotionally drained.
“After 10 such cases, I may feel that it is unsafe to continue, but I could be contractually obliged to see a further 20 patients. A cap could become an expected level of work.”
He said what was needed was more NHS resources being placed in primary care to help when the GP has reached their personal limit.