Many in general practice dread the first weeks in January because we just know things are going to be bad. But why is this? Is it really inevitable, and is there anything we can do to stop it being quite so tough?

The starting point is to understand why so many people come through the door. There are a number of demand side factors that make this such a busy time:

1. Winter illnesses and infections: This time of year brings an increase in respiratory infections, flu cases and other seasonal illnesses, all of which contribute to a higher demand as individuals experience worsening symptoms or complications.
2. Impact of the cold weather: The cold winter weather itself can lead to an increase in accidents, falls and cold-related health issues. Any cold snap during or after Christmas will inevitably contribute to a higher demand.
3. Delay in seeking medical attention: During the holiday season, people often postpone seeking medical attention for non-urgent issues. They avoid disrupting festive plans or assume their symptoms will improve on their own. As a result, after Christmas there’s a surge in individuals seeking care for conditions that initially appeared over the holiday period.
4. Impact of holiday stress: The holiday season can be stressful for many individuals due to things such as financial pressures, family dynamics and travel. Stress can exacerbate existing health conditions or trigger new ones, leading to an increased need for appointments after the holidays.
5. The ‘resolution effect’: The start of a new year often prompts individuals to make health-related resolutions. As people return to work and regular routines, some are more inclined to address health concerns and make appointments for issues they’ve had for a while.

I know this isn’t news, and that every year this combination of factors makes the first week after the Christmas break extremely busy. But the situation is also worsened by supply side factors, by how we organise ourselves over this period, and in particular, by how we manage leave:

1. Holiday leave and reduced staffing levels: A large percentage of staff take some time off during the holiday season (including the first week of January). Sometimes it’s planned annual leave and sometimes it’s sick leave. So we have less staff available to meet these higher levels of demand.
2. Increased workload for residual staff: This in turn means the remaining staff have to take on additional responsibilities and tasks to compensate for absences. This can lead to increased stress, fatigue and even potential burnout, and can increase the chance of them having to take additional leave too.
3. Resumption of regular operations: As a result of leave, services often operate with reduced staffing levels and with limited capacity during the holiday period. After Christmas, as normal operations are resumed, there is inevitably a (further) backlog of cases that need to be dealt with, along with the additional demand that these delays cause.

While the demand side factors remain outside our control, we can have much more influence over the supply side factors – in particular, how we organise leave. This is the topic that our panel discussed in the latest podcast. They don’t go as far as suggesting we should cancel Christmas(!), but they do discuss balancing the need to take annual leave for rest and recuperation alongside the need to meet surges in demand, and how effective workforce planning is crucial to managing the impact of annual leave policies on workload, particularly at busy times like the first week of the year.