GP exhaustion could be jeopardising patient safety, says RCGP

GP exhaustion could lead to mistakes, say the RCGP

The Royal College of General Practitioners (RCGP) has said that fatigue among overworked GPs is now so commonplace that patient safety is at risk "on a widespread scale" unless urgent action is taken.

In its newly-published consultation paper, Patient Safety Implications of General Practice Workload, the RCGP points out that, unlike other safety critical professions where mistakes can result in significant loss of life - such as airline pilots or train drivers - GPs cannot sound a distress signal when they become overwhelmed with tiredness or stress.The RCGP believes that high levels of exhaustion "could have a negative and potentially disastrous impact on their ability to deliver safe patient care", and could result in crucial errors being made, such as mistaken patient identity, medication errors and missed symptoms.

The consultation paper has been sent to the Department of Health, NHS England, the Care Quality Commission, General Medical Council and has also sought the views of various patient groups in an effort to open a debate and identify solutions.

The RCGP claims that what it describes as 'unrelenting and increasing workload pressures' are pushing GPs to their limits as they try to manage ever increasing patient numbers in the face of decreasing resources. It has expressed concern about the changed general practice working environment, where GP surgeries are seeing patients later in the evenings and over the weekend, eroding the time GPs often spend dealing with paperwork such as urgent hospital referrals.

The news follows recent outrage among thousands of frontline NHS staff, who have hit back at Health Secretary Jeremy Hunt's claim that the NHS does not offer a consistent seven day service, with social media hashtag #ImInWorkJeremy accompanied by images of NHS staff working weekend shifts.

The news also coincides with a report in The Telegraph, which claims that new figures obtained from the Health and Social Care Information Centre (HSCIC) under the Freedom of Information Act indicate a steep rise in NHS hospital staff taking time off work for stress, depression or anxiety - up 37% overall in the past three years.

The Telegraph reports that on average, NHS staff took 15 sick days per year with as many as 25 days off sick among some groups including Ambulance Trusts, leading to accusations of a 'sicknote culture'.

But General Secretary of the Royal College of Nursing, Janet Davies, told the newspaper that "the unparalleled demand for the NHS means staff are often unable to deliver the standard of care they wish to".

While safety risks in general practice are lower than those same risks within the hospital setting, the RCGP is still concerned that there remains 'considerable potential for patient harm'. It makes a series of recommendations with the aim of protecting GP wellbeing in order to prevent ongoing exhaustion leaving some GPs unable to provide an adequate standard of care to their patients.

The RCGP recommendations include:

  • Regular, mandatory breaks for staff to minimise the possibility of errors
  • A mechanism to identify practices under extreme workload pressures – and for measures to be urgently implemented to relieve these pressures
  • A full-scale review of how daily pressures in general practice can be reduced – including ways in which existing bureaucracy and unnecessary workload can be safely cut.

The RCGP says that GP consultations rose by 19% or 150,000 patients, over the past five years but GP numbers only grew by 4.1% during the same period, which equates to an additional 61 patients under the care of each GP. Simultaneously, the share of the NHS budget for general practice has fallen year on year to its current 8% - a record low.

The RCGP says a contributing factor is that more patients are also now living with multiple and chronic conditions, and dealing with these complex patients often belies the standard ten minute appointment guideline leading to time constraints elsewhere. Adding to the pressure, the number of patients living with these complex and multiple conditions across England  is predicted to rise from 1.9 million in 2008 to 2.9 million in 2018.

Following the general election in May, the RCGP published what it describes as its blueprint for the future of general practice, Put patients first: Back general practice, a UK-wide campaign which called for an increase in the share of the NHS budget to 11% and for an additional 10,000 more GPs over the next five years.

RCGP Chair Dr Maureen Baker says: “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."

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