“Women Doctors could bring the NHS to its knees!”

Women doctors could bring the NHS to its knees. So says Dr. Max Pemberton in his Saturday column in the Daily Mail (29/8/15).  He adds that is a crisis caused by having too many women doctors. Services across the NHS face closure because women have gone on Maternity Leave or now work Part Time. Two thirds of GP’s are now women.

When I carried out a survey of GP Manpower earlier in the year I carefully avoided making the comment that there were too many women GPs. In fact, I simply took the view that there were too many GPs of all ages both male and female working part time and that was why in my view there was a crisis in GP Manpower. NHS England need to take control again of the allocation of contracts and monitor carefully working hours. Part time GPs need to be encouraged to Job Share and any GPs working less than 4 days need special approval in warranted circumstances.

Here again are my findings.

GP Manpower Survey 2015

During May and June 2015 information was collected about the sessional commitment to the NHS of 312 family doctors who look after around 458,839 patients and work at total of 1,956 sessions.

The average number of days worked by GP’s is 3 and the average number of sessions worked is 6.

Many thanks to the 58 Practice Managers who responded to the Survey which asked questions about days and sessions worked and factors that might reduce face to face sessions such as being a trainer or attending CCG meetings.

The survey also looked at the quality of the services offered to patients. Could patients be seen on the same day or be offered a telephone consultation?

The ‘new’ Working Week

Since the mid 1990’s the trend to work a four day week has grown. In 1995 some 87% of GPs worked full time i.e. 9 sessions over 5 days. Now around 55% of GPs work a 4 day week, arguably the new full time of 7, 8, or 10 sessions. Only 26% of GPs are salaried and in the main work no more than 3 days and 5 sessions.

Recruitment Difficulties

Consequently many practices report difficulties recruiting additional or replacement GPs with doctors increasing their work commitment to cope with demand. Whilst some 26% of GPs have reduced their sessional commitment since 2004 whilst 13% have increased their commitment. The question for practices is what to advertise – how many sessions and how many days are needed.

Simple Sessional Tool

Based on an average personal list size of 1,800 patients an 8 session GP would be responsible for 225 patients. Dividing a practice list size by 225 would give a guide to the number of face to face sessions required in a practice.

Techniques to Handle Demand

Practices are trying various methods to deal ‘demand’ and workload.

  • 93% offer telephone consultations
  • 40% employ a nurse practitioner for about 8 hours per GP
  • 51% employ trainee GPs
  • 84% offer a same day appointment
  • 52% are able to offer the doctor of choice
  • 74% work extended hours
  • 21% work on Saturdays
  • 3% work on Sundays

Manpower Planning

Practices are planning for the future as more GPs retire early and the balance of female to male doctors in general practice changes. Workload demands cause GPs to look for a shorter working week and do not want to own a practice. Here are some pointers to consider when looking for help:

  • Networking – meetings, VTS scheme, CCG contacts
  • Practice List Size – Manage boundary and outliers
  • Shared Advertising and Recruitment with other practices, CCG, Alliances and Federations
  • Partnership Structure – retain balance between partners and salaried GPs
  • Part-Time Doctors – Manage requests for ‘part-time’ working
  • Job Sharing – Use ‘job sharing’ to ensure posts are covered
  • Partnership Workload Agreements – Ensure that new GPs share workload – embody in contract or partnership agreement
  • Curriculum Vitae – Keep Library of CVs
  • Premises Management – Close branch surgery and centralize services
  • Recruitment and Locum Agencies – Use Recruitment Agencies

But Practices are also using other ‘techniques’ to manage services such as Extended Hours, Nurse Practitioners, Telephone Consultations and Triage.

Many thanks to all those who contributed to the Survey – a full copy of report can be obtained from robert.campbell@orange.net.

September 2015 (Revised)

 

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Why are there No GP Appointments?

If BMA figures are to be believed the average GP working nine sessions a week will see an around 23 patients per session. If that is so the average session would take between three and four hours leaving little or no time for other duties.

If the average list size of an individual GP was around 1,800 patients and the average number of times a patient would see a GP in a year was five then in a typical session a doctor would see patients taking just over three hours. The Quality Outcomes Framework originally encouraged GPs to spend at least 10 minutes with each patient.

Prior to 2004 I recall that sessions lasted around two and a half hours but after 2004 sessions started to last up to three and a half hours. In my mind this was due to the shift to computer based records and the need to record everything that moved by using codes and scoring points under QOF. Added to that GPs were being asked often reluctantly to use the Choose and Book referral system. QOF has changed every year and there is now 10 years later a concentration on the more unusual Enhanced Services to such an extent that it makes your mind boggle. At least one GP per practice is expected to take  part in Clinical Commissioning Group activities and the number of sessions needing to be taken out of the working week is increasing by other duties and outside commitments.

Is it any wonder that it is so difficult to get an appointment with the doctor of choice. Some Practices manage it and I believe they only do this by having sufficient doctors to deal with the level of demand. A recent GP Manpower Survey carried out by this web site suggested that on average practices were short of at least one half time GP. The recommendations of the survey suggested that Practices needed to be very careful about allowing any member of the practice to reduce their sessions. It also suggested that part time GPs should work with other in a job share basis so that when absences occur there is always cover. In fact, GPs are expected to provide cover for Extended Hours when they are absent………

Time will only tell whether general practice in the UK can survive without more careful management of GP Manpower and not the ‘free for all’ permitted today.

Robert Campbell – September 2015 (Revised)

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