A new study exploring the hidden work of GPs

By Rachel Barnard

Rachel Barnard offers early reflections on a new NIHR SPCR funded collaboration between Queen Mary University of London, University of Manchester, and Exeter University, to explore the hidden work of GPs: “Hidden in plain sight; the unseen work of general practitioners in general practices in England”.

I’ve found it refreshingly straightforward to explain the GP Hidden Work project to people outside of academia. Unlike my previous research in the speech and language therapy field, everyone has personal experience to hook onto. They have a GP and don’t find it hard to conceive of them doing things behind the scenes. However, it’s never too long before we hit contentious ground. People are frustrated by continuing difficulties accessing GP services and often carry a perception (promulgated on social media) that GPs could be doing more to restore ‘back to normal’.

The problem with normal is that the Covid-19 pandemic has exacerbated a workforce crisis that has been quietly building for years. GP practices are expected to manage expanding caseloads of patients with increasingly complex healthcare needs, with workforce numbers that cannot keep pace. Unable to sustain the pace and intensity of work required to meet demand for healthcare, many GPs are deciding that the only viable way for them to deliver safe care and protect their own wellbeing is to reduce their hours or leave altogether. As potential future patients, we should all be very concerned about how these workload pressures are affecting individual GPs. If GPs follow through on stated intentions to quit, it’s going to mean all of us are likely to have to wait longer for appointments, especially if we want to see our preferred GP.

Photo by SIMON LEE on Unsplash

It seems more important than ever to highlight just what it is that GPs do beyond their direct interactions with patients. I flinch a bit at the word ‘admin’ when used as a shorthand for non-patient facing work. I know from my own clinical experience as a speech and language therapist that liaison with services, writing reports and so on are every bit as patient focused as sitting in a room with a person. As I become familiar with the primary care literature, it’s even more evident that admin is a paltry way to describe the work of clinicians. Ask any GP about their behind-the-scenes work and they’ll tell you there’s an awful lot of it. When a GP refers a patient for specialist attention, follows up on test results or checks medications for prescriptions, they’re drawing on every inch of their professional know how. And there’s more besides, there’s also the business of being part of a Practice, keeping up with new reporting systems, supporting colleagues and so on. GPs estimate that non-patient facing work occupies well over a third of their time.

The problem with hidden work is that, well it’s hidden. It’s not what you see published in national reports of GP activity. This one-year research study will start to unpack the nature of the work GPs do outside of consultations. Working with two GP practices in different cities, we will also explore how hidden work can be researched without paradoxically adding to workload pressures. We’ll be exploring different qualitative methods and involving the practices in workshops that we hope will create space for them to consider local changes that might ease workload pressures. This is a short study, that represents a first step towards a longer-term aim of improving patient care by ensuring policy and resourcing decisions are based on the actual workload of GPs.

The Hidden work research team are Sharon Spooner, Deborah Swinglehurst, John Campbell, Kath Checkland, Emily Fletcher, Rachel Barnard, and Michaela Hubmann.

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