30 July 2015
“GP Fatigue” Threatens Patient Safety
“GP fatigue” is threatening patient health, according to Dr Maureen Baker, the chair of the Royal College of GPs (RCGP)
Dr Baker has warned that the “persistent and excessive workload” family doctors face is risking patient health by making them more susceptible to inadvertently misdiagnosing illnesses or prescribing the wrong medication.
The warning comes in the wake of Health Secretary Jeremy Hunt’s widely criticised push for new GP contracts offering seven-day patient care.
In a paper for the RCGP entitled, “Patient safety implications of general practice workload” - which explores the patient safety implications of high workloads in general practice, Baker warns that “we currently have no strategies in place to prevent and reduce the risk of patient harm that might arise from having tired, overworked doctors and practice staff.”
The College points out that unlike professionals working in other ‘safety-critical’ industries such as the oil, gas or aviation businesses, GPs have no means of sounding ‘distress signals’ in the event they might be feeling overwhelmed with work pressures or fatigue.
The paper highlights concerns by the College that relentless and ever-rising workload pressures are pushing committed GPs to breaking point as they struggle to cope with rising patient numbers and diminishing resources.
Likening the threat posed by such doctors to overtired pilots or lorry drivers, Dr Baker lists a number of ways in which patients could be at risk due to GP fatigue, demanding urgent action to prevent a “devastating” impact on patient care. They include:
- patients being subjected to potentially deadly delays in having their illnesses diagnosed;
- mistaking one patient for another;
- misdiagnosing or over-diagnosing patients who then receive medication or treatment they do not need;
- prescribing the wrong medication or immunising patients with the wrong vaccines;
- failing to properly evaluate emerging evidence of a patient’s illness or failing to monitor their symptoms.
In our experience at Slater and Gordon Lawyers, failures to make the right diagnosis and delays in referring patients for clinical investigations are an area where negligence causes significant harm.
Dr Baker suggests a raft of potential solutions for preventing GPs from becoming too exhausted to provide safe care to their patients. They include:
- regular, mandatory 10-15 minute staff breaks to minimise the risk of errors;
- limiting the number of hours worked and patients seen by clinical staff;
- a system to identify surgeries under extreme workload pressures and measures to relieve these pressures;
- a review into how daily GP pressures can be reduced including ways in which the growing burden of bureaucracy can be minimised.
GPs are having to work longer and longer days due to the increasing number of patients joining their surgeries. Many doctors also have to work extra hours in the evenings and at weekends just to keep track with urgent paperwork, such as hospital referrals. If GPs are persistently over-tired this can naturally, significantly increase the potential for patient harm.
Dr Baker says that the current GP workforce in England is approximately 3,300 too small, with the shortfall projected to grow to 8,000 by 2020. Between 2008/09 and 2013/14, the number of GP consultations shot up by 19% in England alone, while the number of family doctors across the UK rose by only 4.1%.
As more and more junior doctors shun the profession and an equal number of senior doctors retire in the face of growing workloads, efforts to combat the relentlessly growing demand on surgeries are being hindered by the resulting recruitment crisis.
GP surgeries are now seeing an estimated 370 million patients every year in England. This equates to GPs and their teams having to manage an extra 150,000 patients a day compared to 2008. The number of people suffering with more than one long-term condition is predicted to rise to 2.9m by 2018.
The RCGP paper will be sent to the Department of Health, NHS England, the CQC, and General Medical Council for feedback on the debate around GP fatigue and possible solutions to tackle the problem.
The Department of Health have announced they are committed to making an extra 10,000 more staff available for general practice by 2020, including 5,000 more GPs.
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