Some GPs do more than six hours of unpaid work in a week.

We know from recent analysis that GPs contribute around 1.3 billion in unpaid work into the healthcare system each year.

To find out what this looks like in practice, Healthed recently asked over 300 GPs how much time they spent on unpaid work in the past week, and what unpaid activities were taking up the most time.

Around half of the GPs surveyed were part-time, and the other half were full-time.

The survey revealed that the majority of both full-time and part-time GPs do three or more hours of unpaid work in a week.

Around 80% of full-time GPs do three or more hours of unpaid clinical work in a week, and around 40% do six or more.

For part-time GPs, around 60% do three or more hours in a week, and around 20% do six or more.

This result mirrors that of a 2021 study of almost 3,000 GPs, which found that GPs were doing an average of 5.1 hours on non-billable activities per week.

Healthed also asked GPs what type of non-billable work they were doing. GPs could select multiple options.

Most GPs selected: reviewing pathology, imaging, and other specialist results or discharge summaries (selected by 85% of GPs); discussions with other health professionals regarding patient care (selected by 71% of GPs); discussions with relatives regarding patient care (65% of GPs); and managing patient requests made through reception (62% of GPs).

Around half of GPs selected entering patient information into digital platforms, making appointments on behalf of patients and referrals, while 40% selected Centrelink forms.

“These results are surprisingly similar to the results we found nearly a decade age in terms of both of the amount of non-billable work and the type of work (reviewing test results, consulting with other health professionals),” says Dr Christopher Harrison, a senior research fellow at the Menzies Centre for Health Policy and custodian of the Bettering the Evaluation and Care of Health (BEACH) data.

“I think it further supports the results we calculated previously that GPs provide hundreds of millions of dollars of non-billable time a year.”

“I estimate that I personally spend probably an hour or two per session, checking results, making sure the notes are up to date, making sure that the medical file is correct,” says Dr Karen Price, the president of the Royal Australian College of General Practitioners.

A session is approximately a 3-4-hour block of solid appointments. Eight to 10 sessions per week is considered full-time.

“I don’t know how this compares to others, but I’d ballpark up to one hour per session of consulting. Checking results and correspondence, phone calls to other specialties, CPD requirements, and all the other little tasks that don’t meet rebate requirements. It all adds up,” says another GP.

“When our GPs spend four hours in the consulting room, there’s at least two hours of paperwork,” says Angela Walker, a GP practice manager at Warwick Road Medical in Queensland.

“This is not only my professional experience, but this is my personal experience being married to a doctor,” she says.

“Our kids have gotten to the point where we’ll sit down for dinner, and if the phone doesn’t ring, they’ll be like, ‘Daddy, your phone’s not ringing’. His phone will ring at dinner time pretty much every night of the week, and the girls giggle about it now, they’re like, ‘Oh, yep, dinner time. Time to call.’”

“Sometimes it’s pathology, a lot of times it’s the nursing home, sometimes it’s just a specialist at a hospital trying to work out their patient’s history.”

What impact would proper compensation have?

Healthed also asked GPs: “If you were compensated for the time that is currently unpaid, non-billable or underbilled, how would that impact the following factors?”

Over half of responding GPs said they would have more enthusiasm for general practice as a career choice, while 40% of GPs say it would increase the quality of patient care. Almost one-in-five GPs (19%) said they would be more likely to increase their working hours if they were compensated for the work that is currently unpaid.

Over half of GPs (55%) also said they would experience less stress, burnout and demoralisation if they were compensated for this unpaid-but-valuable work.

GPs said they would be less likely to leave the profession (45% of GPs) and less likely to bring their retirement forward (27% of GPs).

As the recently announced review gears up to investigate leakage of Medicare funds, over 90% of GPs would like to see their unpaid contributions acknowledged in the review.

RACGP President Karen Price said that the College would be strongly recommending that the review take a balanced approach to investigating the value of Medicare compliance mechanisms.

“This review is an important opportunity for the College to stand up for our members, and make clear that Medicare complexity and the lack of quality education are the major factors in incorrect billing,” Price said.

“The unfair and unfounded focus on fraud, excessive complexity of the system and fear of being accused of doing the wrong thing is causing unnecessary stress and anxiety for GPs. It’s a disincentive for doctors to join the speciality, and for those practising to keep doing so. It must be addressed if we are to secure the future of world class primary care in Australia, with enough GPs in every community.”

The least productive unpaid work

In the recent Healthed survey, we asked GPs which of their unpaid clinical activities are the most frustrating, pointless or do not contribute to quality patient care.

Close to 40% of GPs selected Centrelink forms, 27% chose patient requests made through reception, 26% chose legal reports, 24% chose insurance claims and 23% chose data entry work.

Around a quarter of over 350 GPs surveyed said all their work was valuable and contributed to quality patient care.

Unsurprisingly, the results suggest that activities that involve interacting with government bureaucracy or insurers, as well as random patient requests were the most unproductive or frustrating activities.

Practice manager Angela Walker made a list of all the ‘free work’ GPs did on a random Friday at her clinic. Her clinic has two GPs.

“I’ve got a massive list in front of me. This is just me sitting down on Friday, thinking about what’s happened in the last 24 hours:

1. In nursing homes, for example, each patient could be on 10 to 20 medications. Every three months, the doctor needs to review that medication chart and sign every single individual medication to confirm it’s still current and accurate. We’re talking about a stack that is 300 pages long. The doctor is expected to do this in their own time, every three months for free. That’s just part of providing the service.
2. On Friday, there was a 76-page discharge summary to review. The patient wasn’t booked for an appointment. That was just an email from a nursing home to say, ‘such and such has been discharged from hospital, please see attached’. The GP has to read and decide whether or not they need to do something with it, not to mention the fact that he’s got to make notes on multiple sites. There’s the complete record held here but then there’s also the nursing home record that needs to be updated. They have to sign in remotely to that — when it works. So, you’ve got to duplicate the notes. Yes, you can cut and paste those, of course, but you’re still doubling the work.
3. Queensland Health will say to you, ‘Oh, by the way doctor, we did all these tests, please log into this portal over here to review.’ They don’t even actually provide them to the doctor, the doctors have to log into a third-party portal to review said results. That happened on Friday as well.
4. Then there’s the discussion with other providers about what to do with patients. We had a call from a podiatrist with one of our patients in their rooms. The patient seemed a little tachycardic on the day. So, they needed to chat with the doctor, to work out whether or not they needed to go to hospital or here to us.
5. And then there were a number of nursing home patients who called to say, ‘I’m just at the pathology place up here but I forgot my referral, can you reprint it for me?’ Or, ‘I’m just getting my x-ray, but I forgot my form, can you reprint it for me?’ And the doctors are the only people who can sign those forms. It’s not like we can just magically print them and send them up, the doctor actually needs to physically reprint and sign them again.
6. Then there’s the discussion with other providers about what to do with patients. We had a call from a podiatrist with one of our patients in their rooms. The patient seemed a little tachycardic on the day. So, they needed to chat with the doctor, to work out whether or not they needed to go to hospital or here to us.
7. There are the extra requests from patients who may have had appointments, but just forgot to ask the doctor about their regular script. Or the, ‘I’ve got this appointment at the specialist coming up and my referral has expired but I can’t get in to see the doctor before I see the specialist tomorrow. Can Dr Walker just do a new referral for me, please?’
8. And, then there’s the requests from the nursing home to say, ‘Oh, you gave us a phone order for this medication. Please sign this medication chart and scan it and send it back.’ And then, they keep calling to say, ‘We haven’t got the medication chart.’ I say, ‘Yes, you have because I’ve sent it back’. We end up doing it again because the nursing home can’t find the medication chart.
9. And then, there’s the chasing of incomplete pathology results.

That’s just what happened on Friday. It’s just constant.”

The bottom line

Ultimately, GPs are private contractors who can raise their prices to cover this expense.

As one GP in the survey said: “All of the above are potentially ‘billable’ just not ‘bulk-billable’.

Another GP said: “I see all these tasks as part of my commitment to patients and part of my job as a GP. Up to now, I had not even cared about not being paid for. Not any more.”

“We’ll be fine because we will transition,” says Angela Walker, a GP practice manager at Warwick Road Medical in Queensland.

This transition is already happening; a recent survey by Healthed shows that one-in-five GPs are moving from bulk billing to mixed or private billing.

But what is being lost in the process is universal access to primary healthcare.

It is disadvantaged patients who will be forced to go to emergency departments because they cannot afford to see the local GP, says Walker.

“The government cannot expect private enterprise to continue to underwrite the cost of providing healthcare services via bulk billing,” she says.

This story was updated to include more survey results on 18 November 2022.