Pressure to meet targets means GPs may miss health conditions

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Increasing paperwork, time pressures and a focus on meeting targets could mean that GPs are missing potentially life-threatening conditions, a study has indicated.

A qualitative study of the experiences of 12 GPs in London found that those in the profession felt they were losing control over their work, which could be putting the health of their patients, and themselves, at risk.

The introduction of performance indicators and targets has “distorted the focus of clinical care onto a small number of conditions”, according to the Job strain and retirement decisions in UK general practice study. It says this has turned clinical practice into what one GP described as a “treadmill”.

“Several GPs gave examples of being so preoccupied with the ‘bean-counting’ of targets that they were in danger of missing the obvious and serious,” the study, published in the journal Occupational Medicine, said.

One interviewee told researchers that they were only “half listening” to a patient while filling out the Quality and Outcomes Framework paperwork – the system for performance management and payment of GPs – when they almost missed the patient having a heart attack.

The study also notes that a “consumerist patient culture” has evolved, which meant GPs were focusing on meeting targets and getting positive ratings and reviews from patients, rather than their primary role in patient care.

A small minority of GPs admitted to holding back from offering clear health advice to patients over fear of offending them, as they were worried that this could lead to complaints or poor internet ratings.

It noted that the pressures were forcing many GPs to take early retirement, with a 40% rise in voluntary early retirees over the past five years.

Study author Dr Jennifer Napier said: “Each GP in the study felt that over time they had experienced a reduction in the control they had over their highly demanding work.

“This research has highlighted the importance of allowing GPs the ability to make their own decisions and providing them with additional resources, the hope is that this will lead to a reduction in job strain and improve the retention of GPs.”

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