The seen and unseen work of general practice: a national diary study of New Zealand General Practitioners.

Abstract

Introduction: General practitioner (GP) work is mostly recognised and funded according to time spent with a patient. However, substantial work occurs outside of patient contacts. This has significant implications for workforce planning and wellbeing, models of care, and resourcing.

Aim: This study analysed the range of activities of GPs in daily practice. It aimed to identify patient-facing and non-patient facing clinical work as well as other activities that are required to deliver comprehensive, continuous, primary health care in the community.

Methods: GPs were invited to participate in two daily diary studies, allocating their activities to six categories. Diaries were completed for 2 weeks in summer (late 2023) and 1 week in winter (mid 2024). Data were analysed to identify the volume of patient-facing work and the range of non-patient-facing clinical and non-clinical activities.

Results: A total of 566 individual GPs completed the diary studies: 417 in summer, 303 in winter, with 154 across both periods. Fifty-six percent of a GP's time was spent on patient consultations, 31% was spent on non-contact clinical work, 7% on training and education, and 7% on clinical governance and running the organisation.

Discussion: Although it is recognised that patient contact time is not the only activity that GPs perform in the course of their work, this study provides details of the range and volume of work undertaken by GPs. A 40-h week in general practice cannot only recognise patient contact time. Consideration of all other unseen hours must be factored into resourcing and models of care.