Friday, 20 September 2013

Bureaucracy and box ticking are compromising NHS primary care

A new BMA survey says that GPs need to be freed from increased bureaucracy, box ticking and administration so they can spend more time meeting the needs of their patients.With that I suspect most of us would agree. 

As I get older, and now suffering from age-related illness, I use my GP more than I ever did before. I have become one of the 'burdens' of 'an increasingly aging population'. When I visit my local GP clinic I am struck by how many of us in the waiting area or in the queue at the reception are over 60s. Until a year ago I rarely visited my GP. I certainly couldn't tell you the names of any of 'my' doctors. Now it is different. I am rooted in that cycle of being regularly poked and prodded. I have become a NHS statistic.

The survey of GP opinion is the largest since changes to the GP contract took effect in April 2013. In total, 3,629 GPs completed the survey, just over 10% of all GPs in England. I worry that only 10% of GPs responded. Perhaps 90% of GPs who didn't respond were too busy ticking other boxes. It does question the representative value of the survey.  But let's for the moment at least take the findings at face value. 

Key findings include: 

97% said that bureaucracy and box ticking had increased in the past year while 94% said their workload has increased.
82% felt that some of the new targets were actually reducing the number of appointments available to the majority of patients.
89% said that more targets will not improve patient care.
90% said their practice’s resources are likely to fall in the next year.
45% of GPs said they are less engaged with the new clinical commissioning groups (CCGs) because of increased workload.
86% of GPs reported a reduction in their morale in the past year.

These results are similar to those of the the seventh annual report into “GP Work life”, funded by the Department of Health, and published this week

The level of overall job satisfaction reported by GPs in 2012 was lower than in all surveys undertaken since 2001.

In the Department of Health Survey, GPs reported most stress due to ‘increasing workloads’ and ‘paperwork’ and least stress due to ‘finding a locum’ and ‘interruptions from emergency calls during surgery’. Reported levels of stress increased between 2010 and 2012 on all 14 stressors, generally by 0.2-0.4 points on a five-point scale. Reported levels of stress are now at their highest since the beginning of the National GP Worklife Survey series in 1998. 

Dr Chaand Nagpaul, Chair of the BMA’s GP committee said:

“GP practices are already struggling with declining funding and rising patient demand, especially from an ageing population. Recent changes to the GP contract have created additional and unnecessary workload that is diverting valuable time away from treating patients. Worryingly 8 in 10 GPs report a reduction in morale, and nearly half of GPs are less engaged with their Clinical Commissioning Groups due to workload."

The government promised to sweep away red-tape and targets. Yet the government recently introduced new targets which include encouraging GPs to carry out a large number of "lengthy and clinically dubious questionnaires" that ask how many hours patients spend on gardening, cooking and DIY.

Absurdly they also introduce a programme offering appointments to all healthy 35-40 year olds simply to check their blood pressure. GPs are very worried that the time taken for this programme and questionnaires is resulting in fewer appointments for other patients who are in need of care.

As Dr Nagpual says, despite this difficult environment, GPs are working harder than ever before. There is a wealth of experience and talent in general practice that could be harnessed positively for patient care. 

“The BMA wants to work with the government to deliver real benefits to patients and remove the administrative burden that is putting pressure on already overstretched GP services. We particularly need to see how we can free up more time to deliver the personalised care that patients deserve and meet the challenges from an increasing number of older patients who need coordinated and effective care.”

GPs should be able to concentrate on ensuring good patient notes and treatment, not filling in forms that are not directly related to patient care.

See also:

Patient safety put at risk by long hours for Junior Doctors
Broken pledges and the crisis in the NHS
Deepening crisis in the NHS

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