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General practitioners are the backbone of the NHS. Collectively sifting, sorting, treating, managing, enabling and listening to more than one million patients per day. We are the risk sink of the NHS: without us the system would collapse under the pressure of undifferentiated problems.
GPs are invariably called upon to ‘save’ the NHS by helping with demand in places as varied as prisons, accident and emergency departments, nursing homes and urgent care centers. We are asked to become general practitioners with special interests in areas where specialists dare not, or don’t want to, tread.
We are also scapegoated for the problems in the NHS. Blamed for not working hard enough, not working nights, weekends or bank holidays. Blamed for being part-time (and a woman to boot), for being sessional or peripatetic doctors, for retiring early or not entering the profession.
GPs are perhaps the most resilient of all the professionals working in the health service. We have a ‘get on with it’ attitude, working beyond the call of duty and cheerfully trying to take up any challenge thrown at us. But given sufficient pressure, each one of us has our breaking point beyond which we can take no more – our resilience finally broken.
Sadly, this is what is happening to many GPs across the country. They are becoming increasingly depressed, demoralised and burnt out. The general practitioner health service was established in January 2017 to help these GPs. This service came about as a result of an acknowledgement in the GP Forward View that GPs needed more support, something the BMA had called for in its Urgent Prescription for General Practice campaign. Six months after launch we can report ‘if you build it they will come’ – GPs are attending this new service in large numbers.
This England-wide service has clinical leads in 13 areas of the country and a network of therapists offering face-to-face, phone and web-based treatment. It offers GPs a variety of group treatments and support in a range of areas, from assessment and case management to helping you plan your way back to work. Most GPs coming to the service have depression, anxiety, adjustment disorder or ‘burnout’. A smaller number have problems with addiction.
The service is already seeing a number of sessional GPs. Being a locum or peripatetic GP is perhaps the hardest of all the roles in our workforce; by its very nature sessional work means that doctors move from place to place. Locums work hard, have little continuity of service or patients, are isolated and often enter and leave practices without meeting any of the permanent staff.
It’s common for younger doctors to take on these roles – moving early on in their careers from the relatively protected training or early salaried environment into the locum world. For these doctors it’s important they do not become demoralised and blame themselves. Most are good doctors working in very difficult places. It is vital that all GPs – but especially those in peripatetic roles – come together, form support groups, learning sets or any other spaces where they can learn, support, suffer, play or just be together.
General practice is going through a tough phase at the moment – but as in the history of our profession, we will adapt and continue to thrive. In the meantime, if any reader feels they need the extra support of a confidential, free, accessible service please contact us. Sadly, the service is only available to GPs in England (from ST1 to one year post-retirement).
GPs can also access the BMA’s Doctor Advisor and Counselling service for support.
Clare Gerada is the medical director of the GP health service and a BMA general practitioners committee member
don't they have gp's in wales with these issues ?
Hats off to you and your team - I came to one of your team's presentations at York - and was impressed with your approach and dismayed seeing the obvious anguish many attendees had or were going through, through no real fault of their own except trying to provide the best service they could.
You blog does worry me. It feels as though support is being supported AFTER the horse has bolted. And this is now the catch 22. If the government who presumeably wishes for there to be a workforce is not doing everything in it's condiderable power to rapidly alter the multiple factors which cause us to develop "Most GPs coming to the service have depression, anxiety, adjustment disorder or ‘burnout'" then by reason is it not complicit in the damage being done to that workforce, and now the twist, by expressing this view have I just proven myself in need of the service.
Luckily for me, the rays of the sun of retirement are just creeping over the distant hills, and like others I expect, I am now working my hardest to create a situation where leaving, no, walking away, is an exerciseable option.
That is another problem. I have always been and still am passionate about Primary Care, and I find the blocks frustrating which if managed could provide a better service for those "serving" and the receivers of the service.
This for me is one of the areas of paranoia. If you need and want a service why would your actions appear to want to break that service unless that was your original intention, or you are just not fit for purpose to manage the service?
My experience is that NHSE seem to say and possibly believe their described strategies and the mechanisms for delivery are an answer. Experience reveals there is little understanding of how to practically implement those ideas to gain traction with the individuals doing the work. Instead another layer of administration is justified and created or another set if data is requested. Common sense is to ask a small test group of patients and practicing clinicians what their views and opinions are abd explore the reality and who mught be best to help make them work. If the government does not wish to do this then what is it's true agenda?
Happy to be contactdd on [email protected]
I will ring your number and report for help tomorrow!
Thanks for your comments. I am trying to also prevent distress. I talk about a three pronged approach. 1) addressing the 'I' - what can I do to improve my health & well being (all of us it's different - for me it's watching come dine with me) and when things get bad how can I recognise I need help and seek it - ideally in a service such as php / gph 2) addressing the 'we' - i.e. What can we do collectively - as teams and practices to improve health & well being & reduce stress. This usually means some practical things such as addressing work load but also must include coming together as teams to have fun/support each other etc and finally 3) what can 'they do'. The they being policy makers and those who make the dangerous mines we are all currently working in. This involves addressing issues such as funding, media, regulation and bureaucracy. This is tough to crack and is where bma GPC and royal colleges come in.
Sorry last comment was from me -clare. Not sure why it posted anonymously
I am sad that our Gold Standard Occupational Health Service in the South West- which was seeing 5-10% of doctors each year and helping more that 83% back into work- was pulled/defunded a year before this new service was set up. We could see an Occupational Health psychiatrist within 5 days and get immediate help. I am not sure a National Service can be that good.
My burnout was caused by the destruction of support services for patients such as a good, well resourced and staffed CMHT, benefits that made it possible for people to live a dignified life, well funded social care/probation/drug and alcohol services. My patients now have nowhere to turn to apart from their GP!