A real-time measurement of general practice workload in the Republic of Ireland: a prospective study.

BACKGROUND: Demand for GP services in the Republic of Ireland (RoI) is increasing, and the resultant escalation in workload demands is an issue of growing concern. Accordingly, the accurate measurement and description of GP workload is essential to inform future healthcare planning. AIM: To provide a real-time measurement of GP workload with respect to hours worked and of proportional time expenditure on typical workload activities. DESIGN AND SETTING: A prospective study among GPs in the RoI that took place from January 2019 to March 2019. METHOD: Participants were invited to enrol in the study by direct email invitation and via notifications posted within GP-specific monthly journals; online forums; and a social media platform. Participants used a time-management software program to self-record workload activity in real time over 6 weeks. RESULTS: In total, 123 GPs were included for final analyses with a total of 8930 hours of activity recorded. The mean duration of a two-session day (excluding break-time) was 9.9 hours (95% confidence interval [CI] = 9.7 to 10.0; interquartile range [IQR] 7.9 to 13.9). Of this time, 64% was spent on clinical consultations. In total, 25.4% of activity was recorded outside the hours of 9.00 am and 5.00 pm. An average of 12.4 face-to-face consultations were completed per session of activity. The mean duration of a 10-session week was greatest for the partner (50.8 hours; 95% CI = 49.8 to 51.9) and >55-year-old (50.8 hours; 95% CI = 49.3 to 52.2) demographics, relative to their respective colleagues. CONCLUSION: To the authors' knowledge, this is the first study to provide an objective, accurate, and granular real-time measurement of GP workload in the RoI, demonstrating the significant volume and variety of work undertaken by GPs in the RoI.

How does the introduction of free GP care for children impact on GP service provision? A qualitative study of GPs.

BACKGROUND: Optimising child health in general practice is a key health service priority. In Ireland, where 23% of Ireland's population are aged under 16, GP consultations have historically involved a private fee or have been covered by Ireland's General Medical Services (GMS) scheme. In July 2015, this scheme was expanded so that free GP care was provided to all children aged under 6 years. Recent research suggests this change in policy has led to a substantial increase in the number of children under six attending both daytime and out-of-hour GP services and highlights a need to better understand the perspectives of GPs on this policy change. AIM: To address these knowledge gaps, this paper aims to examine GPs' views on the scheme and how it has impacted on their practice. METHODS: Sixteen GPs participated in semi-structured telephone interviews between June and August 2016, analysed using inductive thematic analysis. RESULTS: Six key themes were identified: (1) increased service utilisation, (2) changes in parental behaviour when accessing services, (3) increased 'out of hours' service utilisation, (4) dissatisfaction with the current resourcing of the scheme, (5) limited capacity to support expansion of free GP care, and (6) reduced antibiotic prescribing. CONCLUSIONS: The study highlights how introducing free GP care to a mixed private/publicly funded health system may impact on GP workload, parents' interaction with services and physician practice.