Overworked GPs could be putting patients at risk

GPs who are fatigued and overworked could be putting the lives of patients at risk unless action is taken, the Royal College of General Practitioners (RCGP) has warned.

In a new paper published today, titled: ‘Patient safety implications of general practice workload’, the College warns that GPs are unable to make a ‘distress signal’ when they are feeling overworked, unlike workers in other ‘safety critical’ industries, such as aviation, gas or oil. This lack of ‘distress signal’ could result in negative performance or have a detrimental impact on their ability to provide safe care to their patients.

The RCGP has warned that increased workloads have put pressure on GPs to cope with rising patient numbers and insufficient resources. The College has raised concerns over GPs working longer hours in order to see more patients, then spending additional hours after surgeries have finished and during weekends to complete important paperwork.

’No methods or systems for addressing doctor and staff fatigue in general practice’

Speaking about their concerns, chair of the RCGP, 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.”

The new report include suggestions by the RCGP to protect the well-being of GPs by preventing them from becoming over-tired and overworked and in turn protect their patients.

Suggestions include: frequent and mandatory breaks for staff to reduce the risk of errors, a system to recognise practices faced with an extreme workload and support to relive the extra strain they face. In addition, the RCGP has called for a full review of how daily pressures faced by GPs can be reduced and unnecessary work can be reduced.

’Our workload is increasing but our workforce is reducing’

Between 2008/9 and 2013/14, the number of patients visiting local GPs rose with the number of individual consultations up by 19 per cent in England. This is in stark contrast with the number of GPs across the UK which grew by four per cent during the same period, resulting in GPs being responsible for an extra 61 patients each since 2009.

Dr Baker continued: “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. “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.”

General Practices across the country see more than 370 million patients each year in England alone and manage an additional 150,000 patients per day since 2008.

Patients are often living with multiple complex conditions, difficult to diagnose and deal with within a 10-minute GP appointment. While the number of patients in England living with more than one long-term health condition is expected to rise from 1.9 million in 2008 to almost three million by 2018.

These figures come in contrast to the share of the total NHS budget received by general practices which has fallen year on year and is currently just eight per cent in England alone.

’GP fatigue is a clear and present danger to patient safety’

The RCGP warns that while risks in general practices are significantly lower than in hospitals, there is still potential for patients to come to harm due to prescribing errors or mistaken patient identity if GPs become fatigued.

Furthermore, the College stressed that GPs experience extra stress from form filling and preparing for practice inspections from the Care Quality Commission, while recent research by the RCGP revealed an extra 120 hours per GP per year could be spent on patient care by reducing the amount of time doing administration tasks.

Early this year, the College published a ‘blueprint’ on the future of general practice in response to the General Election, calling for a nationally-funded occupational health service for general practice.

Dr Baker added: “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.”

The RCGP paper will be sent to the Department of Health, NHS England, Care Quality Commission, General Medical Council and patient groups to encourage a debate about fatigued GPs and find a solution for the problem.

To read the paper, visit: http://www.rcgp.org.uk/policy/rcgp-policy-areas/fatigue-in-general-practice.aspx