When part time means full time: the GP paradox

Recent workforce data from NHS digital once again show a decline in GP numbers. The statistics are concerning. Despite government promises for 6000 more GPs by 2024, the total number of fully-qualified full-time equivalent (FTE) GPs in England dropped from 29 320 to 27 848 over the five-year period from December 2016 to December 2021. The 1,472 FTE GPs lost to the profession during this five year period represent a 5% reduction in the GP workforce. At the same time, the number of patients registered with GPs increased by about 3.3m.1

To compound this, findings from the latest GP worklife survey by the University of Manchester show that 33% of GPs are likely to quit direct patient care within five years.2 The loss of 33% of GPs would mean another potential 9,174 FTE GPs leaving the profession.

So what exactly is a “full time GP?”

There has been much debate in the media about the meaning of “full time” recently. Many older or retired GPs suggest that a cause for the current GP crisis is a work shy cohort who are not working the hours “we did in my day.” This language is both insulting and ignorant.

The role of the GP now is far more demanding than 20 years ago. There are only so many hours in the day that are safe to work, but so many GP consultations these days can last up to 30 minutes as GPs are dealing with several complex issues. GPs are caring for an ageing and growing population (in numbers as well as size) who are living longer with more complex long term conditions.

In terms of workload and time, including the administrative burden, 8 clinical sessions from 20 years ago is probably the equivalent of about 5 sessions now. Practices may only be required to provide care between 8am-6.30pm, but most GPs work beyond these hours to complete their work. Most GP partners and many salaried GPs are routinely working 12 hour days with little breaks. The fact that many UK GPs are routinely dealing with unsafe numbers of patients is not only a patient safety issue—but is doubtless leading to burnout, clinical errors, and complaints.3

Initiatives such as advice and guidance (A&G), eConsults (secure web forms)—while positively intended, have actually increased GP workload, by adding an extra layer of patient contact and further workload for GP teams. Before A&G for example, the specialist team would see and deal with the patient themselves.

In addition GP teams are now supporting over six million patients on waiting lists for secondary care—many of whom are in pain or distress and looking towards their GP for support. Our day job includes overseeing and mentoring the many allied health care professionals being employed in general practice to try and prop up a failing system.

NHS digital states that a “Full-time equivalent (FTE) is calculated based upon a 37.5 hour working week.4 For example, a staff member working 15 hours per week would be 0.4 FTE, while someone working four 7.5-hour days would be 0.8 FTE and so on.” Many surveyed GPs who work “part-time” clock up 37.5 hours with ease.

While the Royal College of General Practitioners push back against the reports from the media about GP’s working “part time,” it is hard to find a formal definition of what full time means according to the organisation that supposedly represents GPs.5

The BMA model GP contract clearly states that “full-time is defined as 37.5 hours per week.”6 The model contract breaks this amount down to nine notional sessions of 4 hours and 10 minutes per session—although the time of a session can be “altered to suit the parties.”

To allow for clear and transparent discussions into the future, we would urge all GPs in any role to break their job plans into 4 hour and 10 minute sessions. These can then be easily counted, and those of us working FTE in 3 or 4 days can then say “I work full time.”

It may be that many GPs are working 3 “sessions” in a standard day—in which case they should be counted as such.

As the debate to “nationalise” general practice gains momentum, we need to look ahead at defining GP hours in the same way as our hospital colleagues. Otherwise the endless unpaid work that is burning out GPs will remain unrecognised, and the insulting and unfounded criticism of a “part time workforce” will continue to unfairly stain our reputation.