Helen Salisbury: Redefining full time work in general practice

A recent paper in the British Journal of General Practice brought the good news that we have twice as many full time GPs as we thought.1 The less good news is that this hasn’t come about through an increase in posts filled but by making a more realistic estimate of the time it takes to do our work.

A GP’s work is counted in sessions, with each session equating to a morning or afternoon in practice. The BMA model contract for salaried GPs deems a session to last four hours and 10 minutes,2 and the standard NHS definition of full time working is 37.5 hours a week, meaning that a full time contract should involve working nine sessions a week. As every practising GP knows, each session takes much longer than that, and any doctor doing nine sessions is superhuman.

The research looked at data from serial surveys conducted over 11 years (2010-21) documenting the reality of our working lives. This showed that the average time currently taken to complete the consultations and associated paperwork for a traditional GP session is six hours and 12 minutes. This means that GPs are 18 minutes off completing a week’s full time hours after just six sessions, three days into their week. Suddenly, instead of the widely reported one in four GPs working full time, the number turns out to be well over half.13 (There are variations depending on doctors’ roles in the practice, with partners working more hours per session and more sessions per week than salaried doctors or locums.)

This paper has implications for pay and for workforce planning. Currently, doctors’ pay is calculated per session rather than per hour, and a full time salary is predicated on nine sessions. The research finds that GPs working six sessions are fulfilling the NHS definition of full time work but are being paid two thirds of a full time salary. Possibly the reason that it’s so hard to persuade GPs to increase their sessions is that many of them are already working full time, albeit over three days.

The simplest first step would be to redefine full time working as six sessions a week. Another solution, more complex but ultimately more satisfactory, would be to reduce the workload per session so that it could be achieved in the intended timeframe. This is likely to mean seeing fewer patients. Last year the UK’s GPs were reportedly seeing 45-50 patients a day, in stark contrast to many of our colleagues in Europe: 10 a day in Portugal and Belgium; 25 in Switzerland, Italy, and Denmark.4

Many UK doctors work full time hours over three days and spend the rest of the week recovering. It might be better for our patients, improve our ability to provide continuity of care, and reduce our stress levels if the average GP could stop working 12-13 hour days but be present on more days in a week.