GP Workload Survey – 31 July 07
Summary Extract
This paper presents the results of the 2006/07 UK General Practice Workload Survey. The report has been agreed by the Technical Steering Committee (TSC), which includes representatives from the four UK health departments, NHS Employers and the General Practitioners' Committee of the BMA.
The last survey was undertaken in 1992/3, and considered the workload of GPs. This report provides an overview of the entire workload and skill-mix of general practices in the UK in 2006/7 and is the first under the new contract. Staff in a representative sample of 329 practices across the UK completed diary sheets for one week in September or December 2006.
As the survey was targeted at work in the practice it excludes work done elsewhere as well as any work identified as out-of-hours (OOH) not relating to the GMS/PMS/ PCTMS practice contract.
Key Facts
- GP Partners regarded as full-time (i.e. who worked eight or more sessions per week) worked an average 44.4 hours per week in 2006/7. The average number of hours worked by all full and part-time GP Partners in 2006/7 was 38.2 hours per week.
- Practice nurses worked an average of 22.8 hours per week and the average figure for all staff was 26.3 hours. These figures help explain why all GPs represent 20 per cent of practice headcount, but work 25 per cent of the total hours worked in the practice.
- Direct comparison of results with the 1992/93 GP workload survey is difficult. However, average weekly hours for GMS(PMS/ PCTMS) activities, excluding out-of-hours work, are very similar. The average length of surgery consultations with GP Partners has increased from 8.4 minutes in 1992/3 to 11.7 minutes in 2006/7. In 2006/7, surgery consultations with practice nurses took an average of 15.5 minutes.
- Salaried GPs account for nearly one fifth (19 per cent) of all GPs surveyed and those regarded as full-time (i.e. who worked eight or more sessions¹ per week) worked an average 39.6 hours per week. Salaried GPs are more likely to work part-time hours than GP Partners and worked an overall average of 23.8 hours per week.
- The average number of hours worked by all GPs decreased with practice size whilst the average number of hours worked increased with practice size for other staff groups. Regardless of practice size, GMS GPs worked longer hours on average than PMS GPs².
- GPs² estimate they spend 72 per cent of their time on essential services and 10% on additional services. By comparison, other clinical staff estimate they spend 58 per cent and 25 per cent of their time on essential and additional services, respectively. GPs² cover 60 per cent of total patient contacts in practices. The remainder is covered by other clinical staff, with nurses³ covering 28 per cent.
- Non-clinical staff cover over three-quarters (76 per cent) of the non-consultation work time in practices. They spend 37 per cent of their time on data input and practice administration with reception work covering a further 36 per cent.
- Reception staff covered nearly half of the total time spent on repeat prescriptions (47 per cent). Non-clinical staff were responsible for covering nearly two-thirds (64 per cent) of the time spent arranging referrals. On average,˜chose and book' was used for around a third (36 per cent) of the total time spent on arranging referrals.
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Department of Health statement:
"Today's figures show that GPs are spending more time with each patient which is good news for patients. Not everybody who visits a GP surgery needs to see a doctor, for example practice nurses can conduct procedures such as cervical smear tests and blood pressure checks.
"Prior to the introduction of the new contract there were severe recruitment and retention issues and these have now been addressed thereby improving the services to patients.
"We are taking steps to tie GP income more closely to patient experiences, for instance through the GP Patient Survey. We invested significant extra funding in GP services and we expect a certain level of these profits to be invested back into their businesses, to bring about further improvements in services for patients, such as longer opening hours or widening the range of services. The package of measures announced by the Secretary of State last week will help those areas where access to GPs is still an issue for patients."
Charlotte Farrar
Press Officer
Department of Health
GPC Response - GPs under increased workload pressure, says BMA
Family doctors in the UK are working even harder than they did 14 years ago despite working similar hours, according to the results of a new general practice workload survey published today (Tuesday 31 July 2007). The BMA says this is because current consultations with patients are longer and more complex and GPs are increasingly treating patients previously cared for in hospitals, raising the intensity and quality of workload to an all-time high.
Dr Laurence Buckman, chairman of the BMA’s GPs committee, commenting on the workload survey findings that full-time GP partners work an average 44.4 hour week, said: “Since the last workload survey in 1992/3, the average length of a consultation has risen from 8.4 minutes to 11.7 minutes. Research clearly shows that longer consultations deliver better care for patients. On top of this, practices are achieving outstandingly high scores on the Quality and Outcomes Framework in the new GP contract. The survey shows that hard working teams are providing higher quality care for their patients.”
Fair comparisons with the last GP workload survey in 1992/3 are difficult because so much has changed in the intervening years, says the report. Different methodologies and analyses were used in the two surveys. For example, figures for consultation numbers and hours worked in the earlier report include out-of-hours consultations which are not covered in the 2006/7 survey results, nor was the content or complexity of consultations analysed.
Dr Buckman said: “Since the early 1990s there have been significant contractual changes for GPs, and an increase in the number of salaried doctors and the number of GPs working less than full time. However today’s results do show that the average weekly hours for GPs are very similar to those in 1992/3 if you exclude out-of-hours work which was not measured in the new survey.
“What has changed is the way we work. Intensity has rocketed. Patient care that used to routinely take place in a hospital setting – such as diabetic care, cardiac care and asthma care, is now routinely done in general practice. It used to be commonplace to be called to a child with uncontrolled asthma, or a patient with heart failure and send them to hospital. Now it’s a rare occurrence.
“The quality and complexity of GP care has altered out of all recognition from the consultations of 14 years ago and GPs are much more closely scrutinised to ensure that this quality is maintained. As a result, patients are looked after better and nearer their own homes. The way that GPs work now, with their teams, is better for patients, better for the NHS, but it means that GPs are working under much greater pressure, dealing with increasingly complex cases and the other members of the practice team see the more straightforward problems.”
The workload survey shows that on average GP practices have 24 members of staff, with GP partners – the doctors who also run the business side of providing general practice for the NHS - working longer hours than other staff.
Dr Buckman said: “Full time GP partners see over 100 patients a week face to face, give advice to another 20 on the phone, and on top of this make home visits, see elderly patients in care homes and run clinics. The survey shows that although all clinicians in the practice team work hard seeing patients, GPs provide most of the consultation workload.”
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