It’s been, so far, another tough winter on the NHS frontline. In recent weeks, a perfect storm of flu, COVID-19, strep A, and a litany of respiratory bugs has led to exceptional demand in general practice for urgent on-the-day appointments. Many GP surgeries are taking action to limit same- day appointments after being left trying to cope with unsafe numbers of patients on the duty list.1

What are safe workload limits in general practice, and how can these limits be implemented in practice?

Quantifying safe working in general practice is difficult as workload is dependent on practice list size, patient population, workforce, and staffing factors.2 Despite this complexity, I was surprised at the paucity of research around safe levels of working in general practice.

A 2015 questionnaire of 25 European countries found that those nations with more than 25 direct patient consultations per day found general practice unsustainable, with more problems in GP retention and recruitment.3 As a guide, the British Medical Association (BMA) suggests that 25 direct patient contacts a day (at 15 minute appointment times) is …