What do GPs do?
For the past few years, there's been a constant undercurrent of hostility towards the medical field in mainstream media, particularly GPs. Especially from certain conservative former doctors who write in to the Torygraph.
One of the charges levelled against GPs is that they are purpotedly ruining the NHS by not working enough hours. They need to be making more time for appointments and are all shirking.
How do GPs work?
GP work is measured in sessions, defined by the BMA as a 4h 10 minute time slot. 3 hours of this is meant to be clinical time, with some admin time for tasks - meant to be at least and hour. Typically, a whole day will involve a session in the morning and a session in the afternoon.
What do GPs do? The BMA breaks it down here. I also find articles by GPs can be useful for explaining. When not talking to patients, we are sending referrals or liaising with specialists about their care. We are checking blood test results and other investigations that were carried out by the practice, and then informing patients. We are filling prescriptions- each time a patient asks for their prescription to be refilled, a doctor or pharmacist is checking the order and whether it is safe to give, abd whether we are monitiring blood tests and keeping the patient safe. We are reading letters from specialists and actioning their recommendations.
However, in reality, multiple surveys reveal that GPs spend significantly more time working than what they are directly paid for. Whilst a 6 session GP should be spending around 24 hours at work, it's closer to 38 hours on average. GPs report spending up to 40% of their working time on admin - much of it being unpaid time outside of the hours they are contractually hired for. I and most GPs I know routinely stay late at work in order to make sure patient care is completed. We're in before 9am and leave between 7 or 8pm.
Add to that that many might have further responsibilities, especially if they are a partner in the practice.
Funnily enough, full time in general practice is considered to be 8 sessions. That's 4 long days. Gone are the days when anyone would consider a 5 day working week for GPs, because the workload is increasingly intense and sessions generate more paperwork than they used to.
Demand Is Increasing
GPs may be moving towards working less sessions, but that's because our work is getting more complex. As patients live longer, with more complicated combinations of illnesses and treatments, and we exist in a society that has progressively defunded social care and benefits, and impoverished our most vulnerable patients, there are more calls on our time abd attention than ever before. Stripped hospital services are increasingly rejecting our referrals, often inappropriately and against actual guidelines. Services are being pushed onto GPs via shared care agreements that would once have been handled by specialist teams in clinic. Services that we heavily rely on to serve our patients are sometimes defunded or disappear as contracts end or are transferred to new providers. Long wait lists lead to exasperated patients repeatedly seeing their GPs to manage issues that can't be managed well in the community.
There's a narrative in the media that appointments are impossible to get, but in reality, nationally GP surgeries are providing more appointments per month than they did before the pandemic. For example, 25.7 million appointments (excluding Covid vaccinations) were delivered by GP practices in December 2023, an increase of 9% compared to pre-pandemic. Practices are trying to find how to offer more appointments on a budget and how to improve access and find alterantive ways to serve patients; for example online forms, so that phone lines are freed up for vulnerable patients. Many practices are also offering longer appointments as many patients have complex needs.
Let's talk Pay
People also assume GPs are rich, but that's not really the case, especially given most of us wrent working full time. Average pay for a session is somewhere between 10k and 12k a year for each session a week that you work, depending on things like seniority and location. So for example, a 5 session GP earning 10k per session can expect to earn 50k a year. That's barely above the London average salary of 44k for a job that requires medical school, often an additional bachelor's degree and then at least 5 years of postgraduate training at minimum. That's more comfortable than a lot of vulnerable people, but it's nowhere near what most people think. Even if someone is paid higher per session and working more sessions, the average is still closer to 80 or 90k for salaried GP roles.
I've found figures that suggest the average GP salary is just over 100k, but that includes people doing separate private work or being partners, where in reality these are different roles that are paid differently. Partners are effectively shareholders in the practice. Locum or private work is much more lucrative and needs to be considered separately from a standard salaried role.
Some Partners may be earning £100k-150 in a good year, but that will be after working a LOT of overtime outside of their clinics, abd is in line with hospital specialists. The proportion of GPs earning more than that are miniscule. And honestly, if someone is working a ton of extra hours with their local LMC or med school or deanery, or doing a ton of locum work in evenings and weekends, I'm happy for them to be earning more money than me. Extra work and hours should be rewarded.
The Gender Aspect
I think we need to address the fact that complaining about doctors choosing to work less than what is defined as full time, often goes hand in hand with people complaining about women having the temerity to work in medicine. Apparently we're devaluing the profession by making it too female, going part time and having children. Why us ut that nobidy cares about whether men are going less than full time to look after their kids, and whether fathers are missing out on their children's upbringing?
As women, many of us are still facing sexism in our working lives. Whilst still having to deal with the fact that even uf we earn more and work longer hours than our menfolk, we usually end up doing the majority of the childcare and housework. Women in medicine are more likely to go less than full time because we are more likely to feel compelled to take on unpaid labour at home. Like our non medical sisters.
For reference, the full time nursing week in the NHS is 37.5h - with some variation between 36-40h depending on where you work. Working part time would benefit nurses, too. The nursing workforce is mostly women, and yet there's not the same outrage about their working hours or going less than full time, because women being nurses is expected. People don't seem to care about nurses' working conditions or the stresses they are under, and honestly most articles ignore the financial stresses or difficulties of most NHS workers because they are normally focused on doctors as a resource that they want to exploit maximally.
We aren't out there trying to police what hours other professions work - or at least, we shouldn't be. So why does the public feel entitled to dictate what hours doctors should be working? It's not like people are being paid for hours they aren't working!
