Workload of general practitioners before and after the new contract

Abstract

Objective: To assess changes in general practitioners' workload associated with the new contract introduced in April 1990.

Design: Weekly workload diary completed during four weeks in February-March 1990 and during the same period in 1991.

Setting: Sheffield, United Kingdom.

Subjects: All 300 general practitioners on Sheffield Family Health Services Authority list as principals in 1990 and 1991.

Main outcome measures: Mean number of hours worked per week, number of patients seen each week, and mean time spent per patient.

Results: 181 (60%) general practitioners responded in 1990 and 163 (54%) in 1991. Of these, 18 (10%) were not working in 1990 and 14 (7%) in 1991. General medical service work increased during a "normal working week" from a mean of 38.6 hours a week in 1990 to 40.6 hours in 1991, and non-general medical service work decreased from 5.4 hours a week to 4.5 hours. Hours spent on call were similar before and after the contract. For the 99 general practitioners who responded in both years, time spent on general medical service duties increased significantly (40.5 h in 1990 v 42.5 h [corrected] in 1991; p = 0.033), mainly due to more time being spent in clinics. Significantly more patients were being seen in clinics (9 v 14; p = 0.001); the average time spent per patient remained at about 8 1/2 minutes during surgeries and 16 minutes for a home visit, and rose from 13 to 14 minutes for patients seen in clinics. The time spent on practice administration fell but not significantly.

Conclusion: Since the new contract there has been a significant increase in general medical services work, mainly due to more patients being seen in clinics, with no reduction in the time spent per patient.