As a general rule the answer is NO. This is because:
(1) The gaps between fixed clinical commitments are crucial opportunities for communication between team members whether this is as formal team meetings, or informally. Unpaid breaks fail to recognise the professional attitude of GPs who have traditionally been prepared to have working lunches, discussing cases, practice issues, or where there is a high workload, catching up on paperwork.
(2) Short breaks of, for example, 30 minutes, which preclude the GP from absenting himself or herself from the surgery will generally mean that he/she will be considered and treated as available for queries by staff, other health care professionals, GP registrars or patients.
(3) Where workload is exceptionally heavy, a salaried GP would most likely agree to help out with extras or visits over and above his or her agreed job plan even if scheduled to be on a break.
It is helpful to note guidance issued by the BMA in respect of breaks in hospital consultants’ job plans (below).
The BMA consultants’ committee guidance on breaks
A proper balance of work and rest is vital to maintaining a healthy workforce. The BMA thus recommends that consultants should ensure adequate breaks from clinical work during the day. However the BMA believes that the nature of many consultants’ work means that it is rarely possible for them to absent themselves from clinical duties and have a total break. This necessarily professional attitude to patient care means that during a day of clinical activity it is unlikely that many consultants will be able to free themselves from potential interruption so as to allow an unpaid lunch break. The professional nature of consultant work will allow breaks to be taken where possible, but their continuous availability during this time is a benefit to patients. Consultants normally exercise their judgement in taking breaks flexibly, at times chosen to minimise disruption to patient care and to promote the safety of patients.
The BMA consultants’ committee guidance on lunch breaks
There has been much discussion over the question of lunch breaks, and whether they should be included in programmed activity time and therefore paid, or counted as an unpaid ‘gap’ in the day. The answer is perhaps surprisingly simple.
Where there is not a real break from employed activities, then this should be recognised, with no break between Programmed activities. For example, the consultant who attends a lunchtime postgraduate meeting, multidisciplinary meeting or management meeting clearly has no break and the time must count as PA time. Similarly, consultants who eats lunch between cases in theatre, at their desk while reading clinical notes or in front of their computer while checking work e-mails have no real break.
The SiMAP ruling established that time spent at the workplace and at the disposal of the employer counts as work, even if the employee is able to sleep. So, the only sort of break which should be scheduled as unpaid, non-PA time is if there is a genuine break in activity, in particular when the consultant is able to leave the premises and be uncontactable, for example to take lunch in a nearby restaurant, walk in a park, on the beach or to go shopping. This should be stated clearly in writing by management, for the avoidance of any confusion. Further, management should make clear in writing what other arrangements they have made for the cover of patients, clinical emergencies, GP phone calls, ITU or CCU while you are not working at the lunch time. Further, they need to recognise the loss of flexibility and capacity that will follow from consultants needing to get clinical activities ‘wrapped up’ in order to get their lunch break before the next programmed activity begins.
In the vast majority of cases it makes far more sense to accept that consultants are very senior staff who eat lunch flexibly and at times which fit around patient care and without a genuine break from work. Many consultants will not have a lunch break outside of PA time, because few have genuine breaks between activity.
As for the working time directive, consultants have derogated from the rest periods so that compensatory rest can be taken at another time. Although regular breaks are desirable they are not mandatory and in any case the nature of consultants’ working lives makes it difficult to take them at set times.