Duck and dive, 25

Columnist Dr Copperfield examines the connection between manganese, Adele and GP appointments

The number 25: amazing, isn’t it? It’s the atomic number of manganese, the smallest pseudoprime satisfying the congruence of 7n = 7 (mod n), and the title of an Adele album. Extraordinary. I must think of 25 about 25 times a day. Not least because it’s the number that’s going to save general practice.

How? Well, once we exceed the BMA’s safe level of daily clinical contacts – yep, 25 – the current contract not only compels us to signpost without delay, it allows that signpost to point straight to 111. True, NHSE hastily attached a sticky note limiting this to ‘exceptional circumstances’ – but that’s no problem because those circumstances must include when safe levels are breached, aka every day.

Ta-da! A lid on our workload!! Time to breathe, think, perhaps even defecate!!! We’re saved!!!! Particularly when we move from our current fuzzy contract to the new, shiny one, in which I assume the explicit inclusion of the 25 contacts-per-day concept will be central: a triumph if incorporated and strikeworthy if not.

There’s just one problem: that ‘25 per day max’ mantra. It’s been repeated so often, and with such conviction, it’s regarded as sacrosanct. But for the sake of credibility, it must be based on some cast-iron evidence, right?

Trouble is, I can’t find any.

Dig a little and you’ll find the current BMA workload guidance loops back to its own document of 2018, encouragingly entitled Workload Control in General Practice. This acknowledges that ‘there is surprisingly little research on “safe” levels of working’ – and simply dreams up limits of anything from 15 to 35 patient contacts daily, depending on complexity.

OK, but there’s also reference to a 2022 Policy Exchange document At Your Service. This states that 28 patients per day (so roughly 25) is ‘thought to be the safe daily limit’. Thought by who? Thought by the Think Tank, I assume, because it’s not referenced.

All of which means our ‘25 appointments max’ trump card appears to be based on guesswork. I do have some sympathy with the BMA. They’re right to focus on safety to get the public onside – patients don’t care about us being overstretched but they do care about being misdiagnosed by knackered GPs. And yes, I do want a workload cap to avoid me finishing each day as a frothing, convulsive heap. Let’s be honest, if they tried that through limits on consulting time rather than contacts, we’d all have one six-hour long appointment per day, although even that wouldn’t get through some patients’ lists.

And perhaps there is some logic behind the magic number 25. After all, it was probably reverse engineered from the aspiration for 15-minute appointments and patient-contact sessions limited to three hours. But even then, this is argument not through evidence, but evidence created by an argument – one that again simply plucks numbers out of thin air.

Whatever. Clearly, the 25 appointments limit shouldn’t be bandied around like gospel: it would be way too easy for the Government to shoot it down as unevidenced wishful thinking, and bring down with it the rest of our negotiating strategy.

By way of consolation, I’d point out that the National Organisation of Bloggers (NOB) advises that blogs should take no more than 25 minutes. After that, for reader safety, we should down keyboards, even if unfinished. So at this point, the editor can just go and

Dr Copperfield is a GP in Essex. Read more of his blogs here