Covid: GPs' workloads have hit unsustainable levels amid a surge of unacceptable behaviour by patients – Dr John Ip

GP practices across Scotland are currently facing a triple whammy of pressure.

Firstly, the pandemic and restrictions are putting unprecedented strain on how they can operate – something which I’m sure many people are, by now, aware of.

Last year at the start of the Covid-19 pandemic, practices adapted overnight to deliver a safe and effective service to patients: telephone triage, remote consultations, and use of technology to reduce footfall into surgeries, but still being available for face-to-face appointments for those who needed them, such as physical examinations, blood tests, smears and injections.

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Even now, unrestricted booking of face-to-face appointments would mean full waiting rooms, along with the unacceptable risk of community transmission of these new variants of the virus – especially in practices with small receptions areas: the risk to elderly and vulnerable patients is too great and therefore we have to keep these restrictions in place for the time being.

Believe me, GP teams want to see patients again – it is what GPs, practice nurses, and health care support workers are trained for. Remote consultations may be convenient for some patients in the sense that they do not need to leave their homes, but they are stressful and take additional time to gather information and give patients advice.

However, the need to maintain a safe environment for both staff and patients is paramount, and whilst the pandemic continues and new variants emerge, these remote ways of working must also continue.

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Our second issue is GP workload. Even prior to the pandemic, practices were reporting increasing workloads – however, the impact of Covid, and now the effect of lockdown easing, is pushing the number of contacts to record levels.

GPs' workloads are all too regularly hitting double and triple the levels considered to be sustainable (Picture: Anthony Devlin/PA)GPs' workloads are all too regularly hitting double and triple the levels considered to be sustainable (Picture: Anthony Devlin/PA)
GPs' workloads are all too regularly hitting double and triple the levels considered to be sustainable (Picture: Anthony Devlin/PA)

Many practices are reporting patient contacts in excess of 10 per cent of their registered population per week. That would difficult to manage even without the added restrictions of a pandemic in place.

The European Union of General Practitioners has stated that 25 consultations per day is a sustainable GP workload: GPs are now often dealing with double, and sometimes triple that number in a working day with telephone and face-to-face consultations, and home visits.

In 2019, a typical working week for me consisted of 106 consultations on average. Last year, it was 211.

And finally, GP practices are experiencing a surge of unacceptable behaviour from some members of the public which is adding to the strain on general practice.

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There needs to be widespread understanding that the way care is delivered is different from before the pandemic, that those with the highest clinical need will be dealt with first, and the care processes will take time. We see this in the longer waits for hospital care too: things are not going to change overnight.

Despite the overwhelming challenges that they are under, GP practices are, and have been, open all through the pandemic. We are here to provide care and support to our patients, but we are struggling with the immense pressure we are under. Please be mindful that we are people with families and worries just like you.

We are doing our best in very difficult circumstances, and the pandemic is not over yet.

Dr John Ip is a Glasgow local medical committee medical director and a member of the BMA’s Scottish GP Committee

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