Burnout of all staff – not just GPs – is a real concern for practices up and down the country. An incredible four out of every ten GPs have taken or expect to take time off because of burnout as a result of increasing workloads and intense scrutiny, according to a survey by Pulse magazine.
When it comes to practice managers, LMC leaders warned just over 12 months ago that their practice managers are struggling under an ‘unprecedented’ workload since the introduction of the Government’s NHS reforms. A survey of 471 practice managers revealed that two-thirds are considering a new career and the vast majority are feeling ‘demotivated’ in their current job.
The issue came to the fore this week when the results of the BMA poll of GPs – one of the largest surveys of general practitioners ever conducted – highlighted some seriously worrying stats:
- 34% of GPs are considering retiring from general practice in the next five years
- 28% of those working full-time are thinking about moving to part-time
- 9% are considering moving abroad
- 7% are considering quitting medicine altogether
The report also cited various factors that had a negative impact on their commitment to being a GP, including:
- excessive workload – 71%
- un-resourced work being moved into general practice – 54%
- not enough time with their patients – 43%
BMA GP leader Dr Chaand Nagpaul said: “This poll lays bare the stark reality of the crisis facing the GP workforce. It is clear that incredible pressures on GP services are at the heart of this problem, with escalating demand having far outstripped capacity. GPs are overworked and intensely frustrated that they do not have enough time to spend with their patients.
So what can practices do to help resolve the issues outlined above and perhaps avert the need to jump into the difficult task of recruiting a new GP or two?
Clearly extra funding for additional resources would help but seeing is believing when it comes to cash. That means practices making best possible use of the resources they already have. The BMA advice guide titled Quality first: Managing workload to deliver safe patient care offers a number of suggestions on this topic. The guide is well worth reading in full – click here to get it – and don’t be daunted by the 42 page length as most sections contain handy bullet point lists. Aimed at GPs, it actually is of huge interest to practice managers too.
Share the workload
Family Doctor Association chair Dr Peter Swinyard said practices should come together to employ ‘super managers’. He commented: “There is no doubt that GPs cannot run a practice well without a good practice manager. Smaller practices need to start working cooperatively and collaboratively with each other.”
The BMA Guide mentioned above covers this off in detail and suggests:
- sharing HR management, finance management and other back office functions with other practices
- sharing practice managers across practices
- sharing clinical staff or joint appointments, e.g. practice nurses
- providing cross cover for staff absences or holidays
- joint staff training or education
- providing peer support for implementing common systems, e.g. CQC preparation,
- information governance, health and safety, infection control
- if necessary, subcontracting services to another practice
Be better at saying no
GP practices have been faced with a growing workload that is either inappropriate, or outside a practice’s capability or competence. These include:
- patients referred by hospitals back to practices for medication
- fit note certificates which should be dealt with at or prior to discharge from hospital
- wound care management for housebound patients that should be delivered by the commissioned community nursing service
The BMA states that these should be delivered by a more appropriate provider so practice managers need to be better at saying ‘no’.
One of the best ways to deal with the demand-supply issue in the NHS is to empower patients to take more control over their own health. NHS Choices includes information for patients on the appropriate use of NHS services.
Cut out non-NHS work
While all practices have to carry out some non-NHS work, the guide suggests practices should consider whether they really need to work on things such as occupational health vaccinations and reports, private sick notes, insurance medical examinations and passport application countersignatures. Of course practices can make additional money from services like these, so it’s all about finding the right balance between income and resources.
GPs can also decline the following if not reimbursed for work:
- requests for letters or reports regarding re-housing and ‘blue badge’ applications where local authorities should have access to the information they need
- requests to supply patients with letters in support of benefits appeals which is beyond the normal statutory processes to request medical information
Manage practice lists
For practices that are finding that their current level of workload is jeopardising their ability to provide safe care for their registered patients, they can decide to either ask for a formal closure of their list, or take informal measures to close their lists to new patients. Practices could even instigate removal of patients from a practice list.
Older GPs and their concentration
Now here’s an interesting thought. A local area team has issued guidance suggesting GPs should avoid burnout through flexible working patterns that allow older GPs ‘whose concentration goes’ after 4pm to work mornings. The guidance, issued by the NHS England Bristol, North Somerset, Somerset and South Gloucestershire (BNSSSG) area team, says that flexible working arrangements can allow GPs to ‘survive and thrive’ while working harder than ever. Is this practical? Is it ageist or does it make sense? We’ll let you decide.
We’ve purposely focused on practical workload management solutions and haven’t touched on the topics of occupational health support or additional funding – that’s a discussion for a future blog.
How are you dealing with your workload? Do you have any hints or tips that you would like to share? Comment below or take it to the forum.