Average GP now working three-day week after ‘worrying’ drop in hours

The average GP is now working a three-day week following a "significant" drop in working hours, government research shows.

The research, commissioned by the Department of Health, is from before the Covid pandemic – during which concerns have grown that it is getting harder to see a GP. 

There are particular tensions over access to face-to-face appointments, with Boris Johnson intervening last month to say every patient has the right to see a GP in person.

The new figures show that GPs carried out just 6.6 half-day sessions a week – the equivalent of just over three days – in 2019, the lowest on record. In 2010, it was 7.5 sessions. The data also show a fall in the proportion of time spent on "direct patient care". Just 59 per cent of GPs’ time was spent in this way in 2019, down from 63.1 percent in 2010.

The National GP Worklife Survey of 1,332 GPs, carried out by the University of Manchester, shows that the average number of weekly hours "decreased significantly" between 2017 and 2019.  

The figure of 40 hours a week compares with almost 42 hours in 2017 in the first drop since 2010. Meanwhile, rising earnings saw average GP pay top £100,000 before tax and expenses in 2019/20, NHS statistics show.

It comes amid growing concern about difficulties in obtaining face-to-face appointments with a GP. Before the pandemic, around 80 percent of consultations took place in a doctors surgery – but in August the figure was just 57.7 per cent.

Face-to-face appointments

Patients’ groups and campaigners have said many vulnerable people have been unable to access care, with coroners linking a string of deaths to remote appointments.

Dennis Reed, the director of Silver Voices, a campaign group for the over-60s, said: "The situation is really worrying. It’s hardly surprising that we are facing a national crisis in terms of face-to-face access to GPs when the average doctor is only working a three-day week.

"It worries me that when we spend all this money and time training doctors they are able to work part-time, and for many of them that means using that time to work in private practice or doing locum work."

Last month, the head of Britain’s family doctors said he did not expect a return to the previous levels of face-to-face appointments, describing the current split as "about right". 

Prof Martin Marshall said it was not his job to ask fellow medics to work more sessions, saying the model of a full-time GP was "probably something we won’t see again". Surveys of trainee GPs have found that just one in 20 trainee GPs intends to work full time.

Prof Marshall said: "GPs and our teams are working under tremendous pressure – workload is escalating, yet GP numbers fell by 4.5 per cent between September 2015 and March 2021, meaning that the ratio of patients to GPs has increased by almost 10 per cent.

"GPs are burning out and we are seeing high numbers of doctors working less than full time or being forced to leave the profession as a result. Working ‘part time’ in general practice often means working what would normally be considered full-time, or longer, and will likely include many hours of paperwork on top of patient appointments."  

In May, health officials promised to axe a system of "total triage", introduced during the pandemic, and give patients the right to choose to see a doctor in person.

Prof Marshall last month told MPs there was no point making such promises when GPs did not have the capacity to meet them. But Mr Johnson insisted patients were entitled to be able to see a doctor who could give "proper hands-on understanding" of their problems.

The National GP Worklife Survey has tracked workload and job satisfaction since 1999, showing that hours peaked in 2001 when GPs were working almost 48 hours a week on average. But they fell sharply in 2005 following the introduction of a GP contract which saw most drop responsibility for out of hours care, while earnings rose by around one third.

Last month, Sajid Javid, the Health Secretary, held talks with the British Medical Association and Royal College of GPs about how to improve access to doctors. Health officials are examining ways to reduce unnecessary bureaucracy to free up GPs to see more patients.  Ideas under discussion include having pharmacies take on more of their workload.

More than 900 GP practices with the longest waits to see a family doctor have already been ordered to improve access amid concern that too many patients are struggling to get the help they need.

An NHS spokesman said: "The NHS is committed to making primary care as accessible to patients as possible, which is why every GP practice must provide face-to-face as well as telephone and online appointments. Record numbers of people are now training to become GPs, with up to 4,000 new starters this year and rising investment in general practice means that there is funding for 26,000 additional primary care staff by March 2024."

A Department of Health spokesman said: "We are hugely grateful to GP practices for their hard work and dedication. In August 2021 there were 1.21 million appointments every working day, including for Covid-19 vaccination delivered in general practice, which is an 8.6 pr cent increase compared to the same time in 2019.

"We are clear GP practices must take the preference of the patient on board and provide face-to-face appointments to those who want them, alongside remote consultations. We have provided £270 million to expand GP capacity on top of investing £1.5 billion to the sector until 2023/24 to deliver world-class care to patients."

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