Not helpful but harmful

Burnout among GPs has long been recognised,¹ is increasing in prevalence,² and has implications for both clinician wellbeing and patient safety.³ It is widely understood that substantial and continuously increasing GP workloads are a major driver of this burnout,⁴ and competence expansion of non-GPs has often been proffered as a potential solution.^4,5

The NHS has, in recent years, taken various steps to expand the clinical competency of non-GPs in primary care, such as the introduction of advanced nurse practitioners, physician associates, and the Pharmacy First service, which enables community pharmacists to manage seven common conditions such as acute otitis media, sore throat, and uncomplicated urinary tract infection.⁶ This role generation and competence expansion is at least partly intended to reduce GP workload through task delegation and increased ‘efficiency’ of care provision.^4,7,8 The presumed effect of such competence expansion of non-GPs is a substantial reduction in GP burnout. However, without additional intervention, such redistribution of workload achieves the opposite effect.

With non-GPs now increasingly dealing with ‘simpler’ cases, an increasing proportion of GP consultations logically involve more clinically complex patients, such as those with multimorbidity. Simultaneously, GPs are conducting substantially more consultations today than even 6 years ago.⁹ Accordingly, without reducing the total number of appointments per GP, competence expansion increases the average complexity of each GP consultation. Since it is recognised that high patient complexity (such as multimorbidity) increases the likelihood of burnout among GPs,¹⁰ competence expansion is inadvertently promoting burnout among these clinicians.

Competence expansion alone is not a viable solution to intolerable GP workloads. To reduce clinician burnout, an additional intervention is paramount — the total number of consultations conducted by each GP must be reduced. Without this coupling, the rate of GP burnout is likely to accelerate.