The European Union of General Practitioners and BMA have recommended a safe level of patient contacts per day in order for a GP to deliver safe care at not more than 25 contacts per day.

Currently patient contacts per day by GPs in England are significantly in excess of this. GPC England recommends that practices implement an action plan to move towards safe patient contact numbers per day, by moving away from ‘uncapped demand’, towards more structured clinical sessions, with recorded and safe working limits. This will help prevent unsafe levels of patient contacts, protecting patients and staff and in most practices, lead to a reduction in the number of appointments offered each day. Alternative services and sources of support should be effectively utilised to provide extra capacity for patient care, and to help safeguard safe working limits.

Care co-ordinators and appropriately trained reception staff may safely direct patients to suitable alternative services, working to protocol and under good clinical governance. This is in addition to present triaging arrangements used by many practices.

NHS111 can directly book GP appointment slots to a maximum of 1 appointment per day, on the day, per 3000 patients, for practice review and triage. It is for the practice to assess these patients and decide their appropriate management. NHS111 should not re-refer patients to practices. Unfortunately, many practices and LMCs report difficulties accessing the NHS111 Directory of Services (DoS) to confirm they are at capacity and should not be sent further patients.

Many GPs now have access to remote working applications and utilise these to manage their working day and current patient demand. Remote access can encourage a working culture that means GPs work longer hours, for example, by logging in on evenings and weekends. This working culture should be avoided as it is unhealthy and such expectations can also disproportionately impact women and part-time GPs.

Sessional GPs are an integral and crucial component of practices. GPC England recommends involving them in discussions at all stages when you are making changes. This is to comply with employment law related to changes in working practices, but also to utilise their expertise and experience to help shape the provision of patient services.

GPC England also recommends discussing any changes being proposed under the BMA Safe Working Guidance with your Practice Participation Group (PPG) Experience has demonstrated most PPGs are very aware of the unrealistic pressures on all GP practice staff and will support the Safe Working Guidance and may help in clearly communicating your changes to patients.