How to fix doctors’ rotas: vacation policies and mutual respect
BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5049 (Published 09 August 2019) Cite this as: BMJ 2019;366:l5049
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In response to Drs. Liddington, Jones, Chamberlain, Moore, and Fraser:
I have never advised to pass on clerical duties to GPs, and do not believe that is justifiable. However, that is what I have observed often in hospital settings. That is why I stated that "might" have happened.
I hope these false accusations about my article would stop now. The main point of my letter is to illustrate the lack of mutual respect in the NHS nowadays. I never endorse how people dump work to others.
Competing interests: I have been paid to work in both primary and secondary care settings
Excuse me? Hospital doctors might pass administrative tasks that they don't have time for to the patient's GP? Only if Dr. Yeung is happy to come and help me with my pathlinks next week, I'm a bit busy to get them all done.
Discharge summaries and clinic letters containing phrases like 'GP to chase' elicit a strongly worded email to the consultant, with escalation to the medical director if the result is anything other than an apology.
Dr. Yeung, I am not your house officer. A little respect for your primary care colleagues would be nice.
Competing interests: No competing interests
The notion that rota gaps can be partly alleviated by passing clerical work on to GPs reveals a lack of understanding of the crisis within primary care. Our practice currently has a list size per whole time equivalent GP of 3000 patients whilst the national average is 1800. In other words there is a 'rota gap' with 30% of the GP workforce missing every single day.
Competing interests: No competing interests
Perhaps I am somehow misunderstanding Yeung's advice, but a sentence extolling that no doctor should say they are "too senior to complete a task" followed by one advising seniors to pass on clerical tasks to other doctors seems peculiar. Purely clerical tasks should be handled by clerical staff, and if this is impossible then by the person with the most immediate involvement. How clerical tasks on inpatients might be performed by GPs is not explained, but at best would entail delay and steps in the lines of communication. Discourteous, inappropriate and unprofessional "GP to .." demands on hospital discharge and clinic letters are already grossly excessive and frequently contrary to GMC guidance. Given that a much greater expansion of secondary than primary care workforce has occurred simultaneous with a shift of work from secondary to primary care it would seem more logical to suggest that understaffed general practices find a way of passing clerical work to hospitals.
Competing interests: No competing interests
I empathise hugely with the rota issues the hospital teams are subjected to. And agree that "no doctor should say they are too senior to complete a task ". But it is suggested that during rota gaps clerical duties might be passed on to a junior person in another team or the patient's GP.
What if that team or that GP surgery is also under pressure and lacking in staff? For example, telling the patient to request a fit note from their GP requires the patient to contact the GP and the GP to organise the note, guessing at how long the patient might need whereas the specialist would be better placed to suggest a time. Please dont pass on clerical duties to the GP, we have enough already!
Competing interests: No competing interests
I was very disappointed to see the suggestion that 'during rota gaps, seniors might pass clerical duties on to ... the patient's GP.'
I hoped we had moved on from this sort of attitude.
S Jones
Competing interests: I am a GP
Dear Editor
Perhaps Dr Yeung would like to attend a day in a GP surgery to see whether GPs have the time or capacity to take on clerical duties which he feels he cannot manage whilst other colleagues are on holiday. As a GP I don't expect to be treated as a junior doctor by any other member of the medical profession and we are all too frequently asked to "chase the result" in a discharge summary of a test ordered by the hospital. GPs have their own holiday rotas to manage and are already covering the duties of other colleagues within their practices. GPs are already seen as the general dogsbody who try to manage all the gaps in the system that the whole NHS is struggling with. Whilst I understand that rota gaps and understaffing are just as much an issue in secondary care, additional "clerical duties" are not our role and this attitude from a secondary care physician does not help an already overworked system. Patient care will only suffer further.
Competing interests: No competing interests
You need to recruit more junior doctors to fill rota gaps.
Competing interests: No competing interests
Response to Drs. Hazel and Lee
Perhaps you should re-read my letter and previous e-response and see whether you might have misinterpreted the information.
Competing interests: No competing interests