College Chair calls for ‘safety alert’ to protect patients

Britain’s leading GP is calling for a ‘patient safety alert’ to be introduced in general practice so that family doctors can warn when their surgeries are running over maximum capacity, allowing them to access additional support locally. 

Professor Kamila Hawthorne, Chair of the Royal College of GPs - representing 54,000 family doctors across the UK - wants to see a system introduced in every Integrated Care System, modelled on the Operational Pressures Escalation Levels (OPEL) Framework already used by hospitals.

It would enable practices and GPs to flag unsafe levels of workload, triggering support from their local health system. GP surgeries would be able to temporarily suspend some non-priority activities – including some regular health check-ups, certain routine but mandatory staff training, and non-urgent paperwork - during periods of excessive workload, enabling the surgery to reprioritise routine and non-urgent activity and ensure patient safety is prioritised. This power would mirror the flexibility granted by the government to GPs during the COVID-19 pandemic, and allow Integrated Care Systems to work with practices to determine which activities can be temporarily and safely suspended. 'Overflow hubs' could also be set up to support practices in distress at peak times and allow for additional funding for locum cover to temporarily increase a practice's workforce. 

The College’s call comes as the latest survey of its GP members – receiving 1,539 respondents - revealed that nearly half of GPs (46%) said they did not have enough time in their appointments to ensure patient safety. 

This is particularly pronounced in London, with 52% of GPs reporting that they did not have enough time to ensure safe patient outcomes. 60% of GPs in London, Central and East England also reported that they did not have enough time to adequately assess and treat patients during appointments - a result of London having the highest (fully qualified) GP to patient ratio (1 to 2537) for England, according to the latest data from NHS Digital. 

The survey also reveals the significant drain that bureaucracy and paperwork now place on valuable GP time.  Half of GP respondents (50%) reported that over a quarter of their workload was taken up by unnecessary bureaucracy. Within this group of GPs, a substantial proportion faced ‘very high’ levels, with nearly 1 in 5 (19%) claiming that over half their time was spent on ‘unnecessary’ work that had no positive impact on patient care.

The findings are further evidence of the College’s concerns over escalating workloads and rising demand for GP services at the same time as the profession is experiencing serious staffing shortages - which the College attributes to years of under-investment and poor workforce planning by successive governments.   

Last month, general practice delivered 5 million extra appointments for patients than in August 2019 – equating to 150,000 extra appointments per day – all with 883 fewer GPs than in 2019. Each GP in England is now responsible, on average, for 2,300 patients – an increase of over 150 patients from the end of 2019.

Professor Kamila Hawthorne said: " General practice is a safety critical industry yet GPs have none of the mechanisms that other safety critical professions, such as the air traffic industry, have in place to protect them. 

“Our number one priority is the safety of our patients, but GPs are doing more and more to try and meet the rising demand for our services. When you’re fatigued, you’re more likely to make mistakes and our survey shows that many GPs are no longer able to guarantee that the care they are providing to their patients is as safe as it could be.

“We need urgent measures to minimise the potential for any mistakes and that’s why we’re calling for a safety alert system for general practice to protect patients and the hardworking and dedicated GPs and their teams who are caring for them.  While some of our appointments will be brief and routine, the vast majority will require careful consideration from GPs to assess the many competing factors at play in an individual patient's health. This process should not be rushed.

“Patients deserve to see a GP when they need to, they also need sufficient time with their GP and to know that the care they are receiving is the best it can be.  GPs and our teams deserve to do our jobs in a supportive working environment where we can provide excellent care without jeopardizing our own health and burning out.”

She continued: “NHS pressures are not confined to hospitals and there are pressures in general practice all year round, not just in the winter, yet our service is overlooked when it comes to support and funding. 

“The OPEL system has been operating effectively in hospitals for many years and it’s time that general practice had our own equivalent. It will enable practices to sound the alarm and call for help before the care of patients is compromised. 

“This would go a long way to reassure GP teams and their patients. However, the long-term solution lies in much greater investment – both funding and additional workforce - in general practice to compensate for years of neglect. As well as recruiting thousands more trainees, we need a fully-funded national retention scheme to support our experienced GPs to remain on the frontline of patient care and measures to reduce the amount of time that we have to spend on unnecessary paperwork when we could be spending it with our patients.

“General practice is being run into the ground and we need action to stop this, for the sake of our patients, our GPs and their teams and the wider NHS.”

You can also see this story at: "Senior doctor calls for ‘black alert’ safety system in UK general practice" in the Guardian.

Further information

RCGP press office: 0203 188 7659

Notes to editors

The Royal College of General Practitioners is a network of more than 54,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.