‘Unseen’ non-patient-facing work ‘significant and unrecognised’

Almost a third of GPs’ work happens outside of patient consultations, but this is ‘unseen’ in general practice data and remains unfunded in a system that mostly values time spent with patients.
 
That is according to new research by the New Zealand College of General Practitioners (NZCGP) which aims to identify the patient-facing and non-patient facing clinical work needed to deliver ‘comprehensive, continuous, primary healthcare in the community’.
 
RACGP President Dr Michael Wright says the findings ‘shine a light on this growing problem, which we know exists in Australia’.

Published in the Journal of Primary Health Care, the Your Work Counts study of 566 NZ GPs found they spent 56% of their time consulting patients and 31% doing non-contact clinical work.
 
Around 7% of their time is spent on training and education, 3% on clinical governance, and 4% on managing their organisations.
 
‘Despite the varied context of general practice internationally, GPs seem to uniformly spend a significant proportion of time on non-contact clinical work that is unseen by many national data gathering processes,’ the study said.
 
‘GPs themselves recognise that non-patient-facing clinical work, training and education, clinical governance, and practice management are vital to the delivery of high-quality general practice services and to the development of the GP and general practice workforces.
 
‘The failure to fully recognise these unfunded hours threatens the sustainability of general practice and contributes to persistent recruitment and retention issues faced by the GP workforce.’

The authors say the findings also ‘challenge negative commentary about part-time GPs’ and help determine the workload of a full-time GP.
 
If applied to a 40-hour working week, this would comprise 22 hours on patient consultations, 12 hours on non-contact clinical tasks, three hours on education and training, two hours on running the practice, and one hour on clinical governance, they wrote.

Dr Wright told newsGP this study shows the scale and complexity of what GPs are doing in general practice.
 
‘This is a really important reflection because in our daily practice, it’s not just that care our patients need, it’s also the administration we need to deal with when patients are with us, such as telephone authority numbers and other paperwork that we’re completing, and direct clinical care that happens when the patient isn’t in the room,’ he said.
 
‘In Australia, the way we’re funded is that unless the patient is sitting in front of you, you’re not being paid for the work you’re doing.’
 
Dr Wright said the recent RACGP Health of the Nation Report shows the administrative burden and red tape GPs deal with is ‘one of the biggest challenges for general practice’.
 
‘We want to provide more care for our patients, but are increasingly having to complete paperwork or do admin tasks for the benefit of other organisations. It helps our patients but also takes us away from the care we need to provide,’ he said.
 
‘It’s great to see this study, because it really highlights the scale of the non-patient-facing clinical work we do which takes us away from providing direct clinical care, but it is also one of the major contributors to burnout.’
 
A recent newsGP poll of more than 1630 GPs asked what they believe most contributes to feelings of burnout. The top reason for 40% of GPs was ‘not feeling their work was valued’, followed by ‘administrative burdens’, attracting 30% of votes.

It comes as Queensland Health recently undertook a Medical Workforce Wellbeing Survey among 2000 of its doctors, a third of whom were located in regional, rural and remote areas, and found almost half were at risk of burnout.
 
Queensland Chief Medical Officer Dr Catherine McDougall said 49% of clinicians surveyed ‘met the threshold for risk of burnout’, with burnout risk higher in rural and regional areas compared to metro areas.
 
‘We know burnout in the medical profession is not unique to Queensland and it is an issue being faced by health systems across the globe,’ she said.
 
Dr McDougall said the survey data and insights were now being turned into tangible outcomes.
 
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