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Controlling workload in general practice

GP receptionist on the phone
GP receptionist on the phone

Workload is, arguably, the most important factor in managing working conditions for GPs nationally.

It is unsustainable, unsafe and unfair for GPs to be working excessive hours at the expense of their own physical, mental and social health. Given the changes to workforce may take years to be realised, workload must be addressed urgently.

Workload has increased because of growing patient need (complex multi-morbidity) as well as a result of the widespread recruitment and retention crisis and a lack of long-term investment in general practice.

Download the workload strategy (PDF)

 

What the BMA is doing

The BMA is proposing a workload control strategy to enable general practice to improve quality and safety, and to address the recruitment and retention crisis, by agreeing and publicising reasonable safe workload limits, and by providing practices with practical tools with which to achieve workload control.

The case for workload control is clear:

  • There is a need for cultural change within general practice from one of 'quantity overload' amid shrinking resources to one of efficient demand and workload management.
  • There is a need to attract new recruits into general practice and retain the existing workforce.
  • There is a need to maintain the partnership model to protect the future of independent general practice.
  • A lack of capacity in general practice impacts other parts of the NHS.
  • All other parts of the health and social care system can limit workload and activity and this often leads to an unfunded shift of workload to GPs.

 

A workload control strategy

The objectives of the strategy include:

  • Agree a range of clear quantitative limits to help individuals identify what safe practice looks like for them.
  • Produce guidance on the implementation of safe practice across scenarios, illustrating common practice working patterns such as telephone consultations and triage.
  • Endorse or promote the implementation of system change which allows the provision of safe general practice.
  • Propose contractual innovations for practices where rurality or other factors hamper system change.
  • Introduce an "OPEL Alert" system for use by practices and LMCs.

 

Benefits of the strategy

The benefits of applying this strategy can have a positive impact on the following:

  • Improved patient safety and care in general practice.
  • Long-term recruitment and retention benefits by making general practice a safer and more manageable career.
  • Improved GP morale and wellbeing.
  • Practices and CCGs should together see the benefits of safe working at a locality level.
  • Locality working becomes supportive and practice focussed.
  • Practices increase their perceived and real value to the NHS.
  • An integrated primary care system gives general practice a stronger voice in any planning for an Accountable Care System, integrated care arrangement or similar strategic change.

 

What the BMA is doing next

Here are some next steps which we will be focusing on:

  1. Agree the principles behind safe working and work with other organisations to promote its introduction.
  2. Undertake further work to specify precise safe limits to workload in practice settings (expressed in appointments, time or list size).
  3. Produce resources for practices and locality groups with examples of how this model of working can be introduced.
  4. Endorse a locality approach which supports groups of practices, or LMCs, in setting their own safe limits.
  5. Collect and publish examples of hub-based working and workload control from around the country.

 

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Further resources

Quality First

Collaborative working in general practice

Reducing workload through collaborative working

GP practices

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