Skip to main content

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

Comments

Popular posts from this blog

Ian Duncan-Smith says he wants to make those on benefits 'better people'!

By any account, the government's austerity strategy is utilitarian. It justifies its approach by the presumed potential ends. It's objective is to cut the deficit, but it has also adopted another objective which is specifically targeted. It seeks to drive people off benefits and 'back to work'.  The two together are toxic to the poorest in society. Those least able to cope are the most affected by the cuts in benefits and the loss of services.

It is the coupling of these two strategic aims that make their policies ethically questionable. For, by combining the two, slashing the value of benefits to make budget savings while also changing the benefits system, the highest burden falls on a specific group, those dependent on benefits. For the greater good of the majority, a minority group, those on benefits, are being sacrificed; sacrificed on the altar of austerity. And they are being sacrificed in part so that others may be spared.

Utilitarian ethics considers the balan…

Keir Starmer has a lot to offer

The Labour Party is in the process of making a decision that will decide whether it can recover from the defeat in 2019 General Election.  All the candidates have much to offer and are making their case well.

No doubt for some the decision will be difficult.  Others may well have made up their minds on the simple binary of Left-wing-Right-wing.

The choice should be whoever is best placed to pull the party together.  Someone who can form a front bench of all talents and across the spectrum in the party.

That is what Harold Wilson did in the 1960s.  His government included Roy Jenkins on the right and Barbar Castle on the left; it included Crossman and Crossland, and Tony Benn with Jim Callaghan.  It presented a formidable team.

Keir Starmer brings to the top table a formidable career outside politics, having been a human rights lawyer and then Director of Public Prosecutions.   He is a man of integrity and commitment who believes in a fairer society where opportunities are more widel…

No evidence for vaccine link with autism

Public health bodies are worried that an alarming drop in childhood vaccinations is leading to a resurgence of diseases in childhood that we had all but eradicated.  Misinformation and scare stories about the harmful effects of vaccines abound on the internet and in social media.  Where they are based on 'science', it is highly selective, and often reliance is placed on falsehoods. 
Conspiracy theories also abound - cover-ups, deception, lies. As a result, too many parents are shunning vaccinations for their children.  So, what does the published, peer-reviewed literature tell us about vaccincations? Are they safe and effective, or are there long term harmful effects? 
A new report now provides some of the answers.

New evidence published in the Cochrane Library today finds MMR, MMRV, and MMR+V vaccines are effective and that they are not associated with increased risk of autism.

Measles, mumps, rubella, and varicella (also known as chickenpox) are infectious diseases caused by …