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20 December 2021

Why “moonlighting” GPs should not be demonised for taking on extra work

Doctors say that primary care would “collapse” without GPs working privately to prop up the NHS.

By Emma Haslett

As Omicron cases rise, those on the front line are once more under pressure not only from the demands of working for the NHS, but from the public, who are complaining about long wait times and a lack of appointments

This pressure is beginning to turn into mud-slinging. On 15 December, in a tweet that went viral, the former journalist Steve Hawkes complained that a friend had turned to a private clinic after they were unable to make an appointment at their local surgery. “Got Zoom appointment the very next day,” he added. “Logged on and lo! It was their NHS doctor who was too busy to see them earning a bit on the side”.

GPs have been the target of similar accusations for years. But with the NHS under more pressure than ever before, should we ban GPs from making extra money through private work?

Why do GPs take on private work?

Figures published by the NHS in September show that 68 per cent of GPs were contracted to work less than 37.5 hours per week (which the NHS defines as full-time), while another 8 per cent worked fewer than 15 hours per week. Not surprisingly, that figure is higher for women, who typically take on more childcare: 77 per cent worked between 15 and 37.5 hours per week, while 3 per cent worked fewer than 15 hours per week. Which means the vast majority of GPs have a day or two a week in which they can do other things.

Why is that? A London GP we spoke to, who didn’t want to be named, said that in the NHS GPs are counted as full-time if they work four days per week. “You’ll struggle to find a GP who does more than that,” she said. “The job is just so intense.” Even before the pandemic began, two in five GPs reported mental health issues.

In fact, the NHS relies on GPs using their other hours to work as locum doctors at other surgeries. “I have locumed at another GP surgery before because they were short on staff. If GPs didn’t do that, you’d be left in a horrible situation if your regular GP, for example, got Covid. We need doctors moonlighting or the whole system would collapse.” 

Extra work also helps doctors break up their week, she says. Day-to-day work which is “high-risk” can be exhausting. “Some of my colleagues do clinics where they put coils in, others do minor surgeries. It gives them variety,” she says.  

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Others work for private healthcare apps, such as Babylon Health (which also provides an NHS-funded app, GP at Hand). The GP says the allure of these apps is that the work is flexible, and often it’s less “high risk” than conducting face-to-face appointments because the patients are triaged beforehand and either sent to A&E or to see a GP in person if it seems serious. 

The government has driven this move to digital: in September 2018 the then-health secretary Matt Hancock endorsed GP at Hand, calling it “brilliant” and saying he wanted it to be “available to all”. 

How stretched are GPs? 

Figures published by the NHS in September show that there were 36,275 GPs registered in the UK. There are 6,564 GP surgeries, each treating 9,314 patients. A decade ago, there were 39,780 GPs working across 8,316 surgeries, which were each treating 6,651 patients. The number of patients per surgery has increased by around 40 per cent, while the number of GPs has declined by almost 10 per cent. 

Factor in the government’s new target to vaccinate a million people a day – on which GPs are leading the charge – and you can see why they are complaining of being tired. “I am 100 per cent burned out,” says the London GP.

Aren’t all GPs private anyway? 

It’s true that the majority of GP surgeries are privately owned by a group of partners and contracted by the NHS. That’s been the model since 1948, when the NHS was launched, because most GPs operated from home. But most of those surgeries are locally-owned and community-focused, with one client: the NHS. 

We’re in a pandemic. Can’t we force GPs to work overtime?

Most do on the days they’re contracted to work. “We don’t get paid overtime,” says the GP. “If we billed for overtime it would be insane.” Fifteen-minute appointments often overrun, and paperwork adds to GPs workloads which means that many often leave work “two or three hours” after the official end of their day.

She says although surgeries are often closed at lunchtime, it doesn’t mean doctors aren’t working. “We’re doing blood test results and prescriptions. I do hundreds of prescriptions a day: you have to read them properly, because you don’t want to give people the wrong thing.” 

The annual GP Worklife Survey, by the National Institute for Health Research, showed the average GP does 40 hours of work for the NHS per week (compared with the 37.5-hour “full time” working week cited by the NHS). Some 89 per cent of GPs said that increasing workloads are one of the main stresses of their jobs, with 82 per cent saying “having insufficient time to do justice to the job” was a major factor. More than three-quarters said they don’t have time to carry out all their work. Bear in mind that the most recent version of this data is for 2019 – the year before the Covid pandemic began. 

Why can’t we ban GPs from private practice? 

Banning GPs from private practice won’t increase the amount of time they have available to work for the NHS, because they are contracted to work for a certain number of days. As the GP points out, many use private practice to break up their week, but most prioritise their NHS work. 

“Many GPs in the UK work portfolio careers, with a mixture of roles,” said a spokesperson from Babylon. “Our GPs tell us that adding remote digital work to their working week helps them to avoid burnout.”

“This widespread vilification of hard working GPs and our teams is unfair, it’s demoralising and it’s indefensible,” said Martin Marshall, the head of the Royal College of GPs, in October.

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