‘Hidden’ no more: the real work of the ‘part-time’ GPs working full-time hours

[摘要] The King’s Fund recently conducted a survey of 318 GP trainees, and found that less than a third of them intended to work full-time (defined as eight sessions per week) upon qualifying. Most trainees felt that five to six clinical sessions was about right. The top four reasons for not wanting to work full-time related to workload issues, including the intensity of the working day, volume of administrative work, work-related stress, and long working hours.1This mirrors previous research looking at qualified working GPs. A survey of GPs in Wessex found that 26% of GPs had reduced their working hours to help manage the increasing intensity of workload and the effects on mental health and stress.2Is workload actually increasing? It would seem so. The British Medical Association (BMA) looked at workload control in general practice and described increasing consultation rates due to growing patient needs, complex multimorbidity, a recruitment and retention crisis, and a real-term fall in current NHS investment into general practice.3 All of this means that there is an overload of work with diminishing monetary and workforce resources to manage that work.THE REALITY OF GP SESSIONS How this increasing workload translates into a working day effectively shows why counting whether GPs are part-time or not using the sessional system is flawed. The BMA defines a session as a 4 hours and 10 minutes period of duty, typically consisting of 3 hours in direct consultation with patients with time left over for other tasks.4 How does this translate realistically into the working day of a GP? A typical day is hard to define. Time spent on each consultation will depend on the GP, the complexity of the case, and how many extra tasks are generated from each clinical contact, for instance, referrals or organising investigations. Alongside the clinical contacts and related work are the additional test results, personal call-backs, prescription requests, and clinical documents to process, all of which can easily extend a 4-hour session to 5 or 6 hours. When sessions overrun, a six-session working schedule starts equating to 36 hours a week and looks less like a ‘part-time’ job than a full-time one.The recent GP Worklife Survey unpicked the split between sessions and hours worked in more detail. The average number of sessions worked in the survey sample was 6.3, but the average number of hours worked was 38.4, which would normally equate to around eight sessions. The Worklife Survey responders spent 40% of their time on indirect patient care (referral letters, filing test results, and correspondence), administration, and meetings.5 The current sessional split of 75% (3 hours of a 4-hour session) for clinical care and 25% for administrative work doesn’t quite capture the reality of the indirect patient care workload in practice.

[学科分类] 卫生学