Overworked GPs risk patient safety

GP FATIGUE due to overwork threatens patient safety on a "widespread scale", says the RCGP in a new consultation paper.

The College claims that unrelenting and increasing workload pressures are pushing GPs to their limits – having to cope with growing patient numbers and diminishing resources. It says that GPs are working longer days seeing patients, followed by many hours after surgery and at weekends trying to keep up to date with urgent paperwork, such as hospital referrals.

The College acknowledges that safety risks in general practice are inherently lower than those in hospitals but warns that there is considerable potential for patient harm through medication errors, mistaken patient identity and other risks.

GP consultations between 2008/9 and 2013/14 rose by 19 per cent in England alone yet the total number of GPs across the UK grew by just 4.1 per cent in that period. GPs are also seeing an increasing number of patients with multiple and chronic conditions which are more difficult to deal with in a standard 10-minute consultation.

In the consultation paper – Patient safety implications of general practice workload – the College offers proposals for protecting the wellbeing of GPs to prevent them becoming too exhausted to provide safe care to patients. These include regular, mandatory breaks for staff to minimise the possibility of errors and a mechanism to identify practices under extreme workload pressures – and for measures to be urgently implemented to relieve these pressures.

The paper also calls for 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. Recent research by the College estimated that an additional 120 hours per GP per year could be spent on frontline patient care by reducing unnecessary bureaucracy.

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.

"Few of us would voluntarily board a plane flown by a visibly tired pilot or get on a train where we knew the driver had spent too much time at the controls – yet there are no methods or systems for addressing doctor and staff fatigue in general practice.

 "Even in other areas of the NHS, 'distress signals' – such as red and black alerts in hospitals – exist so that other clinicians can simply declare that they cannot take on further work safely.

"But unless we disrupt patient services – which is the last thing that GPs want to do – we currently have no strategies in place to prevent and reduce the risk of patient harm that might arise from having tired overworked doctors and practice staff.

Baker adds: "Our workload is increasing but our workforce is reducing as thousands of family doctors approach retirement and insufficient numbers enter GP training to replace them, with the result that more family doctors are having to work unsafe hours to get the job done.

"GP fatigue is a clear and present danger to patient safety – and we urgently need to find workable solutions that will keep our patients safe now and in the future. The long-term solution is greater investment in general practice and more GPs. We must do everything we can to 'recruit, retain and return' thousands more GPs to prevent hardworking and dedicated GPs being lost to patient care through ill health."