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Distress signal system needed to spot GPs at breaking point

RCGP wants mandatory breaks and distress signals system

Adrian O'Dowd

Wednesday, 29 July 2015

A system that spots when GPs are dangerously tired due to workload pressures is needed to prevent patient safety problems, claims the RCGP in a major new consultation launched today.

The college has issued its Patient safety implications of general practice workload consultation paper which makes radical proposals for protecting the wellbeing of GPs to prevent them becoming too exhausted to provide safe care.

GP fatigue is a serious risk to patient safety, warned the college, which has called for:

  • regular, mandatory breaks for staff to minimise the possibility of errors
  • a mechanism to identify practices under extreme workload pressures
  • measures to be urgently implemented to relieve these pressures
  • a full-scale review of how daily pressures in general practice can be reduced
  • finding ways to safely cut existing bureaucracy and unnecessary workload.

The document says that fatigue amongst overworked GPs is becoming so common that it could jeopardise patient safety on a widespread scale unless urgent action is taken to address this.

GPs, unlike professionals working in other “safety critical” sectors, such as aviation or the oil and gas industries, could not sound a “distress signal” when they felt overwhelmed or struggling with fatigue.

Although the safety risks in general practice tended to be lower than those in hospitals, the college warned that there was still considerable potential for patient harm – such as medication errors, missed diagnosis and mistaken patient identity – if GPs were persistently over-tired.

The college said unrelenting and increasing workload pressures were pushing GPs to their limits.

The consultation says the proof of this is shown by the fact that numbers of people attending general practice grew between 2008-9 and 2013-14 by 19% in England alone, from 303 million to 361 million.

Over the same period, the total number of GPs (headcount) across the UK grew by just 4.1%.

GPs and their teams were now seeing around 370m patients per year in England and general practice was managing 150,000 extra patients a day compared to 2008.

GP stress and fatigue was being made worse by the growing burden of red tape and bureaucratic burdens, caused by form filling, box ticking and preparing for practice inspection visits by the CQC, said the college.

The consultation paper will be sent to the Department of Health, NHS England, CQC, GMC and patient groups for their views.

RCGP chair Dr Maureen Baker said: “Our intention is not to panic patients but to send out a pre-emptive strike to ensure that we take steps now to protect patients from the risks arising from doctor and staff fatigue.

“GP fatigue is a clear and present danger to patient safety – and we urgently need to find workable solutions that will keep our patients safe now and in the future.

“Few of us would voluntarily board a plane flown by a visibly tired pilot or get on a train where we knew the driver had spent too much time at the controls – yet there are no methods or systems for addressing doctor and staff fatigue in general practice.

“Even in other areas of the NHS, ‘distress signals’ – such as red and black alerts in hospitals – exist so that other clinicians can simply declare that they cannot take on further work safely.”

Responses to the paper are invited by 25 August to policy@rcgp.org.uk

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