Why GPs need permission to say no – or we risk losing them

I’ve written many times about the pressure of workload, how that’s affecting GPs and some of the tactics they can use to address the problems that a heavy workload is creating for them.

But it’s a problem that is really coming to a head now, especially with the new instruction in the GP Contract update that general practices must deal with whatever lands on them on the same day. Whereas before, they had the option to tell the patient to call back on a different day, they now have to be seen, assessed, signposted or dealt with there and then.

I have been talking to a Local Medical Committee about a workshop I’ll be delivering for them later this summer, and this issue prompted very good questions. Why aren’t GPs allowed to be full? And what can be done to give them some headspace?

GPs are not allowed to be full

Roughly 90 per cent of patients first come into the NHS via their doctor’s surgery. They may be referred elsewhere or signposted to another service, but the simple fact is GPs are currently delivering a volume of appointments – including face-to-face – above what they were doing pre-pandemic.

Yet it’s the only part of the NHS that is not allowed to be full.

Every other area of practice can say ‘Don’t send us any more patients today; we’re full.’

Hospitals can go on black alert and insist no more patients are sent to their A&E departments.

When outpatient departments get overrun, they have waiting lists. So it’s not uncommon to wait to be seen for an outpatient appointment for six months, nine months, even more than a year. It’s the same in diagnostics. If you look at the published diagnostic backlogs and waiting lists, they’re nowhere near the six-week referral to diagnostic treatment target in a lot of areas. But that’s all completely acceptable. How so?

Think the politicians will help? Forget it

Just recently, the politicians have promised an increase in the number of GPs by anything up to an extra 15,000. There are all sorts of numbers being plucked out of thin air with absolutely no detail on how they’re going to do it, how they’re going to find them, how they’re going to recruit them or how they’re going to train them.

What they’ve announced isn’t a strategy, it’s a soundbite, it’s simply not grounded in reality. It takes seven years to train a GP and the politicians of today will not be there in seven years’ time greeting these people off the training line.

They’re also saying all sorts of nonsense about people definitely being able to see a GP face-to-face which just belies what is going on in general practice right now.

It’s worth remembering that a lot of patients waiting for secondary care treatment end up back in general practice because they feel unwell, they’re in pain or not coping. They go back to see if the GP can speed up their appointment for treatment which of course isn’t in the GP’s gift. So it’s a really frustrating time.

The five questions a GP must answer before saying ‘yes’

So in my line of work, I spend time trying to help GPs create headspace and look at how they’re working. Because the reality is they’re usually drowning in workload and simply haven’t got the people to meet the demand. So there’s an ever-pressing need to innovate and work in new and different ways in order to create more capacity. Opportunities to do that come through the Primary Care Networks and GP federations.

Once I get the opportunity to work with GP practices, my goal is usually to get them to start saying ‘no’. That may sound obstructive but is simply designed to get them to step back and ask themselves the following five questions when they’re approached with projects or people offering them money to do things.

  1. Does this idea fit in with your business plan? Does it fit with where you want to go and what you want to achieve?
  2. Does it significantly improve the patient outcome over what you’re doing now? Because if not and you’re just tweaking at the edges, then what’s the point in giving up your time for it?
  3. Is the project going to relieve workload pressure on the GPs and the wider practice teams? Obviously this one is absolutely key given the current environment.
  4. What impact does the project have on income? There’s no point taking on projects that collapse your income unless they are going to result in a massive workload release. I have some clients who would be prepared to forego a little bit of income for less workload.
  5. Have you got the workforce available to deliver this project? Or at least, can you get a workforce that can deliver this project?

If the project passes all five tests then take it on. If it doesn’t, that’s the time to say: “Great idea, thanks for the offer but no, we’re not taking it on.”

But because of a lack of headspace and because you’re not allowed to say no or be full, all too often these projects are taken on, even though they don’t add up. And that just makes things worse.

Where would we be without general practice?

So I ask the people I’m working with to take a realistic look at every opportunity they’re given and work out if it’s right for them before they leap in with both feet because they are just not allowed to be full.

Patients are very intolerant of not being able to get an appointment. We don’t have that intolerance in other aspects of our lives. If I need the car serviced I need to plan ahead, I can’t just ring them in the morning and get it done that same afternoon.

Ok, so healthcare doesn’t work like that because when we’re unwell we need to be better fast. But a lot of it could be self-resolving – if we did a bit of self-care and looked after ourselves a bit better, we could relieve some of that pressure on general practice.

If we keep piling on more and more we really are at risk of losing the jewel in the NHS crown. Goodness knows what state we would be in then.

Accepting the fact GPs are never allowed to be full gives us an opportunity to step back, look at the way the system works, create that all-important headspace and maybe say no more often.

If that doesn’t happen, then we’re facing a downward spiral. You can read my blog about helping GPs avoid burnout here.

Create the right environment, and GPs can flourish

The solution to the problems GPs are facing isn’t just training up new people and plucking numbers out of thin air like the politicians do. It’s much more about creating a good environment that people want to stay and work in.

We need to put the joy back into general practice and remember that it’s not always been like this. When I first started working as a consultant 18 years ago, I remember a general practice in Wigan advertising for a partner and they had more than 500 applicants. Now you’d be lucky to get one – and that’s the real shame of where we are.

But I sincerely believe all is not lost. In fact, I’ve witnessed this for myself through the work helping my own customer base move forward. If you’d like to understand how you can pull your practice around, do feel free to message me on LinkedIn. I’m always happy to chat.

Scott McKenzie helps GPs, PCNs and GP federations build sustainable and resilient practices and organisations that thrive. If you want to know how to double your revenue and reduce the overwhelm, Scott can share these processes with you too. Schedule a call today.