GPs Working For Free To Complete Crucial Patient Follow-up – Study Shows

The well-documented workforce shortages have meant that
specialist GPs and rural hospital doctors are having to take
on more work and work longer hours.

To understand how
widespread this issue is, and how it is truly impacting our
membership of over 5,800 specialists, The Royal New Zealand
College of General Practitioners developed the ‘Your Work
Counts’ project. The aim is to identify how much time is
being spent on key tasks and addressing the unrecognised and
often non-remunerated work that GPs put in to caring for
people throughout the course of their lives.

The data
collected will help the College to develop evidence-based
guidelines around:

1. What a fair and reasonable
40-hour week looks like

2. Safe and sustainable
patient loads

3. Ratios for how many GPs per 100,000
patients each region, and the country, needs

College
Medical Director and Tauranga GP Dr Luke Bradford says,
“Until now, most discussions about the way we work have
focused only on the patient-facing aspect. The College
wanted to highlight the amount work that is actually
required to look after a primary care patient load as a
specialist GP or rural hospital doctor.

“The results,
below, clearly show the demands being placed on the
workforce and that there needs to be a change in thinking
around GP workloads and the funding model.”

The
results

Over 400 members completed the project’s
first diary study. At the end of every day for 14 days,
including weekends, participants recorded the time they
spent on five key tasks:

1. Contact time (patient
consultations)

2. Non-contact clinical time

3.
Training and education

4. Clinical governance and
practice improvement

5. Management (running the
practice)

see below for full results on task
breakdown

Not surprisingly, clinical contact time with
patients took up the most time over the two-week period –
56.4%.

Non-contact clinical time, which consists of
all the paperwork, emails and administrative tasks generated
from patient consultations came in second at 30.8% of
participants’ time.

Dr Bradford explains, “These
results show that over an 8-hour working day (without
breaks), 4.5 hours of patient consultations generates 3.5
hours of follow-up work and helps to explain why getting an
appointment can be difficult.

“To make ourselves
available to see more patients, many choose to move the
non-contact clinical work into our evenings or weekends, or
sacrifice training, teaching or clinical governance time to
complete it. This is the work that we are not remunerated
for, despite it being a core part of our role.

“For
our hospital-based specialist colleagues, their clinical
time accounts for approximately 70% of their role. However,
this incorporates the non-contact clinical work for their
patients. All health professionals have patient follow-up,
so why is the way it’s remunerated and structured so
different?”

Looking at the hours that participants
worked over the two-week period:

– 57 respondents
(14%) worked all 14 days in the study

– 64 respondents
(15%) worked all four weekend days

– 76 respondents
(18%) worked at least one 50+ hour week

– 34
respondents (8%) worked 50+ hours each week

– 22
respondents (5%) worked at least one 60+ hour week

– 7
respondents (2%) worked 60+ hours each week

College
President and Wellington GP Dr Samantha Murton says, “The
breadth and complexity of care we provide is unlike any
other medical specialty. We’re working longer hours to try
and plug the gaps of the workforce shortages because we want
to be available to patients when they need us. But these
extra hours of work, paired with all the follow-up work that
comes with it, is not a long-term solution.

“We do
this work because it needs to be done. It is a key part of
our role. Imagine the consequences if we didn’t make that
referral, email a specialist, schedule a procedure or review
test results.”

Dr Bradford says, “Having dedicated and
remunerated time to do important patient follow-up and
administrative work during the day is not an unreasonable
expectation to have. Neither is working more manageable
hours and having a sustainable patient load.”

The
‘Your Work Counts’ project will be running another diary
study which will be easier for members to take part in
during a period that suits them. This will allow us to build
on this data and further support the College’s advocacy
efforts to have the profession valued appropriately for the
work that they do and the complexity of the care they
provide, and that reflects their individual
situations.

RESULTS AT A GLANCE

Time spent on
key tasks:

Consultations: 56.4%

Non-contact
clinical time – 30.8%

Training and education:
6.4%

Clinical governance and practice improvement:
2.6%

Management (running the practice):
3.3%

Other: 0.5%

Demographics of
respondents:

Gender

Female: 312
(75%)

Male: 102 (25%)

Gender diverse: 1
respondent

Preferred not to say: 2
respondents

Ethnicity

European: 351
(84%)

Māori: 16 (4%)

Pasifika: 5
(1%)

Asian: 57 (14%)

Middle Eastern, Latin
American, African: 3
respondents

Location

Urban: 332
(79%)

Rural: 48 (12%)

Not clearly urban or
rural: 37
(9%)

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