Managing your workload

There’s no doubt about it, general practice is a tough environment to work in.  Whether you are a clinician, administrator, or practice manager, the workload can seem unmanageable at times.

The current model of general practice encourages easy access to world-class healthcare between the hours of 8am to 6:30pm. 

Sadly, workforce and premises constraints have meant that it can be hard to meet the needs of patients without working at a high intensity for long periods of time.  The risk associated with this is fatigue, leading to a reduction in quality of care, and burnout.

This has caused many of us to look for short-term solutions until such time as the healthcare workforce challenges are met.

So, what options do you have?

Practices must provide enough appointments to meet the reasonable need of their patients, however, these must be within safe bounds for patients and GPs.  There is no definition of how many patients a clinician must have contact with each day.  This leaves flexibility for practices to determine what is “reasonable” and safe.

The European Union of General Practitioners and BMA have recommended a safe level of patient contacts per day in order for a GP to deliver safe care at not more than 25 contacts per day.

Remote consulting with triage as appropriate are safe and effective ways of delivering care. Utilising these methods may allow practices to provide patient appointments more flexibly, direct patients to the most appropriate provider of care, as well as prioritising care for those most in need.

Practices are able to change their appointment books however they see fit. 

Many practices still provide care at 10-minute intervals, including note keeping, and ‘housekeeping’ between patients.  However, this is at odds with similar primary healthcare systems, and with evidence that demonstrates quality of care .

Being more flexible with appointment times can preserve the quality of care provided, preserve patient satisfaction, and reduce the need for repeated consultation with patients, without increasing the total time GPs spend consulting in their day.

The Additional Roles Reimbursement Scheme (ARRS) entitles PCNs to access funding to support recruitment across reimbursable roles.  There was a significant underspend in 2020/21 meaning that many posts were not filled, contributing to workforce shortages.

Practices should engage their PPGs and openly discuss the challenges being faced by all practices, and specific pressures locally.

The support of and consultation with PPGs is vital in any changes that practices are considering.

GMS regulations allow practices to provide “services delivered in the manner determined by the contractor’s practice in discussion with the patient”.

PPGs are an important conduit for communicating these changes, and reasons for them, to the wider patient population.

They may also be able to lobby on behalf of practices directly to CCGs, demonstrate patient engagement to CCGs, and give crucial insight into the needs and priorities of the patient population.

Practices do not have capacity to undertake work passed to general practice from outside agencies.

This may include un-resourced, noncontractual work coming from secondary care e.g. undertaking tests, or referrals on behalf of secondary care providers.

Practices have no contractual obligation to undertake this work, and can legitimately say “no.”