Maybe it’s time to HALT…

Hungry, Angry, Late, Tired? Then maybe it’s time to HALT…

A discussion paper from the RCGP specifically concerned with fatigue caused by persistent, excessive workload, examines the Patient safety implications of general practice workload. It’s a really interesting read.

Workload has increased significantly. Deloitte’s estimate that the number of GP consultations in England rose from 303m to 361m between 2008/09 and 2013/14, an increase of 19%.  At the same time case complexity has risen, with the number of patients in England with multi-morbidities set to grow to 2.9m in 2018. Patients with multi-morbidities can account for up to 78% of all consultations.

Hungry, Angry, Late, Tired? All in all it is perhaps common-sense that where one or more of these factors are present, people are more likely to make mistakes.

Fatigue is well understood as a possible root cause of safety incidents, given that it affects our concentration and ability to complete tasks successfully. Most, if not all safety-critical industries recognise fatigue as an important cause of error and harm. This is widely understood by the general public. Two common models are used to illustrate core concepts of patient safety – the ‘Swiss Cheese’ model and the ‘Three Bucket’ model. See if they resonate with you.

Burnout is a different beast from fatigue – although Doctors showing shows of such may be at risk of burnout  – which occurs when the workload of an individual is greater than his/her ability to deal with the demand. A survey by Orton, Orton and Gray found that 46% of doctors reported high levels of emotional exhaustion,  combined with 42% who reported high levels of depersonalisation and 34% who had low levels of personal accomplishment.

GPs are not alone in feeling the strain. It also impacts on Practice Nurses and other general practice staff. Research shows that Practice nurses perceive that meeting QOF requirements makes up a large proportion of their workload.

The RCGP recommends that the best solution will be for practices to have the infrastructure, workforce and financial resources that allow them to scale up services in respond to legitimate patient demand. Meanwhile, things need to be done in the short-term. Strategies that might be considered by government and regulators are identified:

• Review potential for reduction in daily pressures
• Limiting the number of patient contacts that clinical staff will have in one day
• Limiting the number of hours worked by clinical staff
• Practices insisting on regular breaks for staff
• Review existing interpretation of professionalism
• Temporary postponement and permanent reduction of contractual or regulatory obligations
• Consider impact of NHS initiatives on GP capacity

The RCGP is looking for innovative solutions being tried at practice level to reduce the risk of fatigue and reduce workload, as well as regional or national level suggestions. The College welcomes comments from all members of the general practice team, as from healthcare professionals outside of general practice, patients and policy makers. Write to policy@rcgp.org.uk

Sue Lacey Bryant
Primary Care Workforce Development Tutor
Sue.LaceyBryant@thamesvalley.hee.nhs.uk  

Reference

RCGP July 2015, Patient safety implications of general practice workload