The ever-increasing demands being placed upon GPs are unsustainable, if they continue we risk overworking our doctors and damaging the health of patients. Whilst a single request from another body or individual for information or activity may seem harmless and quick to handle, the reality is that GPs are being inundated by requests from all quarters.
Being a family doctor is a privilege, but also involves managing the unfounded expectation that a GP is there to perform everything and anything they are tasked with by patients, commissioners, or the wider health and social care system. These requests come in their droves despite the fact that GPs are harder-pressed than ever, while still being expected to provide unlimited general medical services for just £142 per person, per year. With funding and resources stretched to the limit, it is imperative that work additional to the core contract is funded.
Practices fulfil many such requests under the historically agreed ‘collaborative arrangements’ that supposedly exist between the NHS local authorities – arrangements which are not part of GPs’ NHS contracts. In order for doctors to complete their obligations to produce reports they must take time away from patients – putting more strain on a system already at breaking point. Reimbursement is not an attempt by GPs to line their own pockets, it is about covering costs to ensure a practice can still provide the same number of appointments while a GP is spending time writing reports. Every hour a GP spends writing a report or a letter equals up to six 10 minute face-to-face appointments lost. Notwithstanding the importance of many such reports, such as safeguarding reports for local authorities, even these need to be reimbursed to allow practices to backfill GP time and maintain practice operations for patients. Indeed, my colleague, Dr Elliott Singer, has recently written to London local authorities raising this issue.
GPs across London and further afield are also frequently named by schools and employers as providers of sick notes for children or adults who have been ill for less than seven days. There is no legal requirement for GPs to provide such sick notes, nor for schools to ask for them. It is up to a parent’s discretion as to whether or not their child is able to attend school on a given day. For advice on managing coughs and colds parents should speak to their local pharmacist – who will be able to assist in most cases of minor illness, and if it is something more serious will refer them on. These seemingly innocuous requests for GPs to fill out sick-notes squander GP time and often waste an urgent appointment slot that could be used by another patient.
Similarly, GPs get requests for letters in support of housing applications, but local councils and the Department of Work and Pensions have told us they will not accept these as supporting evidence unless they specifically request them. We understand that these patients are frequently in desperate circumstances, but a GP letter won’t help and just takes up time which could be spend addressing other health needs.
When we last surveyed our member practices on demand for non-contractual work, 69% said they experience a high level of demand for medical assessment letters (for use with insurers, the DVLA and others); another 69% said they experience a high level of demand for letters relating to housing applications (for use with local authorities and the Department of Work and Pensions); 57% experience a high level of demand for letters to certify that a person is not fit to undertake a particular activity (mostly for use with employers); and 41% experience a high level of demand for letters to certify that a person is fit to undertake an activity (for extreme sports, marathon running, etc).
Also of concern are the increasing number of tasks widely out of general practice’s remit that are landing on GPs desks. Following the Grenfell Tower tragedy, GPs were asked by NHS England to run through a four-question checklist regarding fire safety with those patients who live in high-rise buildings. Asking at-capacity GPs to take on responsibilities which should lie with landlords and management agencies is ludicrous, particularly when they already struggle to meet patients’ health needs in the ten-minutes allocated for consultations. Four questions may not seem like much – but diverting the time to identifying which of the 60 or 70 patient contacts a day may need fire safety advice and then providing this advice, places practice staff and doctors under unnecessary pressure.
More and more, GPs are being asked to certify people to undertake certain activities, leaving them open to legal risks: certifying over-75-year-old’s fitness to drive every year was floated; checking a patient’s nationality as part of the Home Office’s health tourism plans is now a requirement; I could go on. These requests bear little relationship to the medical role GPs are required to perform, nor are GPs necessarily the best person to use to address these needs.
An individual may be on a GP’s patient list, but this does not necessarily mean that that GP is aware of any conditions that they might be suffering that should prevent them from holding a firearms license – that patient might not have visited the GP in months or years. Likewise, I cannot see any benefit in providing Home Office nationality checks – all that will happen is people will begin to avoid going to the doctor and their health and the community’s health will suffer. It is not a GP’s job to provide a monitoring service for all arms of Government and making them do so just increases distrust in the medical profession and puts undue stress onto their relationship with patients.
Our GPs are expert generalists in primary care and family health. The demands we place on them must play to their strengths and benefit the health of patients if we are to retain both individual GPs, and the profession for the years to come.