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Gold, incentives and meh

Burnout forces almost 10% of GPs to take time off work as pressure on occupational health services grows

Exclusive One in 11 GPs has taken time off work due to stress or burnout within the past 12 months, and as many as a third expect to do so within the coming year, according to a Pulse survey that lays bare for the first time the impact of GP burnout on the wider NHS.

It comes as the Practitioner Health Programme, the largest service in Europe for doctors with health concerns, revealed the number of new doctors and dentists seeking help has more than tripled in the past four years.

Asked whether stress or burnout was affecting their ability to work, some 9.3% of the 688 GP respondents to Pulse’s mutli-topic survey said they had had to take time off within the past 12 months. A further 32.5% said they had not taken time off but thought it was likely that they might need to in the coming year. The remaining 58.2% said they had not had to take time off work and did not expect to.

The findings comes as part of Pulse’s Battling Burnout campaign, which aims to raise awareness of the problem and lobby for better monitoring of GP workload and better occupational health support for those who need it. A separate Pulse assessment earlier in the year of almost 1,800 GPs using the validated Maslach Burnout Inventory tool found that 43% are classified as being at a very high risk of developing burnout, with partners and those working in deprived areas particularly badly hit. 

Professor Clare Gerada, the immediate past chair of the RCGP and new medical director of NHS London’s Practitioner Health Programme (PHP), said the programme was now supporting between nine and 11 new doctors or dentists each week, compared with around three new practitioners a week four years ago.

Professor Gerada told Pulse: ‘The two groups we have most contact with are GPs and A&E doctors. The increase is partly because more people know about us, but there is certainly an increase in illness levels as well. The word burnout is used to describe this but I don’t like the term, because it’s actually depression given a more acceptable label.’

She said a number of factors were to blame for doctors’ plummeting morale over the past year.

‘Change always produces anxiety, but we are also seeing the denigration of NHS staff in the media, where we are being blamed even though most of us are trying to do a good job,’ she said. ‘It feels like GPs are seen as both scapegoats and messiahs. People want us to save the NHS through commissioning, but they also blame us for the problems.

‘My message would be to hang in there, because things can only get better.’

Today’s findings follow a GPC survey published in September, in which a huge majority of GPs reported they were battling excessive bureaucracy, facing a shortage of resources and suffering from low morale. Some 94% of GPs said they had experienced an increased workload since the imposition of the 2013 GP contract in April.

GPC deputy chair Dr Richard Vautrey said that the 40% reduction in QOF points agreed for the 2014 GP contract was a ‘step in the right direction’ in reducing GPs’ stress levels, but added: ‘Nobody should be under the misapprehension that this will make a major difference. Most of all we need additional resources so that we can take on more GPs and nurses to meet the patient demand.’

Survey findings in full

Have you had to take any time off work for stress or burnout within the past 12 months?

Total number of respondents: 688 GPs

No, and I do not expect to: 400 (58.2%)

No, but I think it is likely I may need to in the next 12 months: 224 (32.5%)

Yes: 64 (9.3%)

About the survey

Pulse launched this survey of readers on 15 October, collating responses using the SurveyMonkey tool. The 26 questions asked covered a wide range of GP topics, to avoid selection bias on any one issue. The survey was advertised to readers via our website and email newsletters, with a prize draw for a Samsung Tab 2 tablet as an incentive to complete the survey.

As part of the survey, respondents were asked to specify their job title. A small number of non-GPs were screened out to analyse the results for this question. GPs were also asked on a voluntary basis to provide their GMC number and the majority did so, although these were not verified or used to screen out respondents.

 

 

 

Readers' comments (38)

  • A third of GPs may need to take time off work due to stress in the next year? Wow.

    I think HMG don't understand the time bomb they are sitting on. Or perhaps they do, and they don't care.

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  • I work 50-60hrs/week but feel this is managable (for me). My family is complaining as they never see me but that's part of being a GP's family.

    Could I manage if the work load goes up more? Probably not. I will be leaving the partnership to do locum/OOH if this happened before I go insane.

    GPC are on different planet if they realistically think "40% reduction in QoF" will translate to anything like 40% reduction in work done by GPs.

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  • The profession has been changing rapidly over the last 20 years and it is deeply different from the way it was 10 decades ago. Doctors and physicians occupied the highest rung on the social ladder. Doctors were permitted to dine with the family during home visits. A physician’s fee was wrapped and placed nearby, for theoretically gentleman did not accept money for their work...
    A different job, a different place in the society.
    I suspect many doctors find themselves doing something that hardly looks job it was when they started practicing.

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  • 2 points....
    1. This does not represent those who have chosen to leave and avoid burnout and stress.
    2. The government don't care. They have no respect whatsoever for GPs and know that when Romanians and Bulgarians are allowed in, a significant number of doctors will be among them. A BBC interview last week showed a group of Romanian doctors who said that a very significant number of them were planning to head for the UK in January.

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  • Bob Hodges

    Ah, the hypothetical Romanians and Bulgarians.....

    They won't be able to work as GPs without language exams, and possibly MRCGP equivalent. Any organsiation employing them will be responsible (as they have been since Dr Urbani etc).

    I'd be amazed if they are able to get indemnity insurance to practice in the UK as independent GPs, and would be massively pissed off if my subs go up to subsidise them.

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  • Big Big problems but our Parlamentarians do not realise or could not care .Can do Lip service .
    Please do survey in current system of PCT ?CCG
    do occupational Acess for GP 's exist??
    Unfortunately they Burden further their Gp colleagues ,
    Extrely Sorry state of Affair .No one to care of carer Professionaly

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  • as above

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  • The Romanian doctors interviewed last week had excellent English and were highly intelligent and employable. They said that the wages available in the UK were massively higher than there.
    Equivalent qualifications within the EU must be recognised and it is illegal to discriminate.
    Why do you think the situation for Romanians and Bulgarians will be different from polish doctors who came here a few years ago? There are many excellent, fluent English speaking polish GPs, one of which is taking over half of my workload when I leave at the end of December.

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  • I would be curious to know what are the figures in terms of retirement. I should not be surprised if several GPs in their '50 would decide to leave soon rather than later, particularly now that some "management roles" may be available. How to blame them? There is a need to step the profession up, but things are going the other way around.

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  • Bob Hodges

    Doctors from India also have excellent English, and look at the MRCGP exams. There should be no backdoor for new 'European' doctors - if they're good enough they can come and have a go just like everyone else.

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  • Irrespective of who might replace them, these figures are a national disgrace, and politicians must shoulder a big part of the blame.

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  • Fascinating that GPs weren't interested inindustrial action (or rather went for 'ciritical engagement') to stop an abiomination of a Bill pass through, or in support of other healthworkers pensions, but are keen to pull a sickie when it lands in their lap! Not so engaging now are we? I wonder how supportive the public/patients will be of a proffession giving themselves (un)fitnotes - copy of the Daily Mail anyone? is this a profession, almost literally, shooting themselves in the foot?

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  • I think doctors are the least likely of any profession to 'pull a sickie' and any decision to take time off work is a major one and would not be done lightly. To suggest otherwise is offensive.
    Just because we were not all interested in industrial action, this does not make us weak - we simply have integrity and are putting the patient first. It is not the fault of the patient that this government is so hard of hearing. Any industrial action would simply feed those irresponsible journalists/politicians/trolls with lots more headlines of lazy rich GPs. We would not have the public support as long as the media remains so one-sided.

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  • Ahh I see that one of the resident trolls is back - never takes long, does it?

    It's interesting that you equate stress / burnout with "pulling a sickie" - charming. I think the public will be pretty supportive when it takes even longer to get an appointment or indeed when their local surgery shuts down. Extra kudos to your GP for tolerating you.

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  • Stress goes with the territory and we're compensated well enough compared to our average punter.It extends to other professions and medical specialities as well.We're not unique.So if you can't stand it then medicine isn't for you so get out!

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  • Re: Anonymous 11.30am - our job is stressful but the qualities that make us empathetic, caring GPs can also make us vulnerable to burnout. Cheers for the compassion - glad you're not my GP!

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  • Tom Caldwell

    Unfortunately it seems that according to the media General Practice is idle, under educated and underworked and we must be brought into line to take pressure off the hardworking hospital Drs.

    The reality of a hard working group of professionals working at and beyond capacity for continually reducing investment does not fit with the right wing story the media is happy to peddle as truth.

    Stress goes with the territory yes, but this cannot be used as an excuse to destroy lives.

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  • So if you can't stand it then medicine isn't for you so get out!
    --

    Ditto to the above poster. I suspect you're not actually a GP and I sincerely hope you're not an appraiser or similar.

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  • Trolls within the ranks?
    I'm a fulltime GP with a history of depression and I find the job very stressful and I have to monitor carefully where being a bit burnt out isn't going to be the start of something more. My depression came from many angles but once I sorted out my commitments I found it fulfilling and therapeutic to cope with the job and the rest of my life. Nothing in the last 9 years of the 'new' contract has helped me stay in control of workload, nothing in the newest contract does so either. In fact it will worsen it and I am ready to jump ship rather than let the job make me ill. A busy job I can cope with; unreasonable demand for reducing 'reward' (emotionally and fiscally) and scant regard of leaders to mainitain our professionalism (rather than our trade) i will not and can not.

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  • Secure environments GP

    Anon 11.30am, that opinion is exactly what is wrong with the culture in medicine, we are human, we hurt, overcompensate, we work in GP land taking on enormous complex workloads with time pressures which can force stress reactions in anyone. The constant Government and Daily Mail "GP bashing" is demoralising. Some colleagues have an awful unsupportive view on stress and mental health problems, accidents are just waiting to happen daily with a work-force under such multiple pressures. Stress, burnout and depression is sure to be affecting the lives of doctors and their patients to significant levels now as proven by these surveys and will only get worse. Tipping point is long past. I was lucky that the Area Team was so supportive of me and Occupational Health services have been excellent. As for some colleagues, they can "walk on a broken leg" if they want, but I am glad I know many GPs who are responding positively with compassion and empathy.

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  • We do not get compensated well at all. You have no clue about primary care do you!

    I'll take out the fees to make it comparable to hospital colleagues. My gross (i.e before tax is taken out) hourly rate as a GP partner in average earning practice after employer's pension contribution and indemnity fees and course fee taken out is £30/hour. Bearing in mind I'm an employer with all the risks of an employer (which hospital consultant do not have), this is poor pay. Try and find a consultant happy to work for even double our hourly rate - you won't find one.

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  • my practice was in danger of being swamped by new registrations I had a higher average list than those around before you counted their Salaried locum Nurse practitiones and trainees etc. I applied to close the list, local practices contacted only 2 bothered to reply and they were quite happy for us to close, and the LAT said no. I am fine but do I have to keep going until I collapse? We have to be in charge of our workload.

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  • Can you not decide on a list size and then decline new registrations until you get to your target ?

    As long as you have reasonable grounds to turn people away i.e. not enough staff, and reject with no discrimination, then surely you can decline and reassess registrations on a daily basis.

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  • >the LAT said no

    That's crazy. You should write back advising them that if the list keeps increasing you won't be able to guarantee appointments or safety and ask for the name of the person stopping you. Let them know you will hold them responsible for anything that occurs.

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  • The 'if you can't stand the heat get out of the kitchen argument' is rubbish, and propagated by those who fail to fully engage with patients and therefore never experience the full stress of caring. Politicians have never understood this and it is sad that some of our colleagues don't either. There are some aspects of a G.P.s job which cannot be compared to other professions, we can start with the care of the terminally ill.

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  • These figures do not include those of us who are getting out BEFORE we become ill with burnout. With a heavy heart from leaving a job I love, but with a huge sense of relief, I have 4 weeks to go before leaving GP partnership. I have been inundated with letters and conversations with my patients expressing thanks for my care and regrets at losing the continuity and personal care I have provided, but every single one of them has said they understand why I am leaving. The Secretary of State has just announced a new Contract "to bring back old-fashioned GPs". Its a shame he hasn't made more effort to keep the ones he already has/had!

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  • One of our youngest partner called in sick earlier this year. Just couldn't take the work load anymore and has since left the partnership. We now have only one partner that was here 4 years ago - rest has retired. I can only hope our newest recruit can take the pressure

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  • Sooner or later, every healthcare organization must realize the math of providing healthcare. The foundation of patient satisfaction and quality care is the health and life balance of the providers - physicians and nurses. If you simply treat them as wheelbarrows into which you load more and more tasks and responsibility ... they will burn out. You can't give what you haven't got. You can't be compassionate or even patient when you are burned out. There has to be a balance struck between work and the provider's personal health and well being. Without this balance you get mediocre care, and burnout.

    Dike
    Dike Drummond MD
    www.TheHappyMD.com

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  • Dike Drummond MD

    well said and I completely agree !

    unfortunately our leadership and 'representative' bodies couldn't give a **** about us. We have been abandoned and are left with making our own individual career decisions. It is hard to support our patients when we receive no support our selves. At this point I'd rather scrap the NHS and start from scratch!

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  • Being A GP has become very stressful, if it was just demanding none of the GP,s would have complained but as the volume of workload is increasing, incentives are disappearing, GP are being blamed left right and centre for things which happen and both do not happen. It is like GP are expected to know the problem like a specialist, be nice like a GP, keep the referrals and costs as low as possible. I am getting confused who are we responsible towards The Patient or the Goverment?
    We are certainly asked not to prescribe this, not to refer for this, not to send to AE, not allowed to do certain things ourselves?????
    Is is just the GP's who get treated like a doormat?

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  • I'm afraid i have no sympathy for you lot.You claim that you're overworked and burnt out but it doesn't seem to show in the quality of your referrals.As a hospital physician i see daily evidence of your intellectual laziness.Alot of you can't even be bothered to take a basic history and arrange some elementary investigations.A common complaint i hear from patients in A/E is that either they couldn't get through to their GP or were told to just head off to A/E.Are you guys paid per number of patients you bounce off to us?Since the 2004 contract alot of the GP partners have simply been taking the taxpayer for a ride.You have relinquished your duty to properly care for your patients.Most of the GP workload at my GP surgery and many others in the area is shouldered by the salaried docs and no partner does more than 2-4 sessions/week.So when the government asks you to do a proper day's work you all go screaming burnout!

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  • Anon at 10.51
    ..a little unfair.

    This is not really the place to vent your frustration at your spouse's inability to secure a GP partnership.

    Furthermore in these testing times the last thing the medical profession needs is numptys like you attempting to pitch doctors one against another.Why not come off your high horse and show a little dignity and consideration to your fellow colleagues rather than engaging in gross unfair generalisations .We have Mr Hunt and the national press insulting us on a virtually daily basis,we don't need you doing the same.

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  • whether you are a gp or a hospital dr - we have ALL been let down.

    the problem is that society doesn't want to face up to it's responsibility and make a decision on the form of state healthcare it wants backed up with the funding for it. Society wants perfect healthcare (no errors) with zero harm, local staff (speaks the Queen's English who won't spend their time getting pregnant, having families and will devote themselves to servitude), they want the BEST doctors in the world (who will also work for minimum wage), and want the BEST treatments in the world with unlimited free access to it and free at the point of use BUT society doesn't want to cover the costs! So the buck is passed to the very front-line folks who provide the face-to-face care. The pressure then results in tit-for-tat exchanges with one front-line group attacking each other. so far IMGs, female doctors, GPs, A&E Consultants, nurses etc have been targeted.

    I say stuff society and pass the problem back !

    Time to leave the NHS.

    Let society pick up the pieces !

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  • "I'm afraid i have no sympathy for you lot.You claim that you're overworked and burnt out but it doesn't seem to show in the quality of your referrals"
    ----

    Err this doesn't make sense at all. Surely being overworked or burnt out would indeed lead to poor referrals? Or would you expect overwork to lead to better referrals?

    I call foul play here - you can't possibly be one of our Consultant colleagues - your comments are too stupid!

    "A common complaint i hear from patients in A/E is that either they couldn't get through to their GP"
    -----

    A common complaint that we here is that Consultants didn't listen at all and that the standard of care in hospitals is awful. Does this also make it true?

    Totally bizarre - seriously, you can't be an actual Doctor!

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  • Leave the nhs on mass, go private, job done. Do this or stop moaning. Simple - happy private GP

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  • Indeed, GPs deserve to be looked after too, they are only human being just as everyone else in the society. Burnout is a superb and precise description of the working status of most of them. Working from 8am-8pm, many of them arrived at the surgery premises at 7:30am or even earlier, this is an on-going status year after year. How can one keep energetic with such working hours and the stress under. They may put themselves into health risks.

    Looking after those aged over 75, 24/7, is not realistic underpinning what they have already had on their daily 'dos'. The carers system may be able to cover this.

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  • Dangerous when Doctors sit in silos criticising each other over inter-silo communication problems. "I understand the body but not the head,' is a frequent type of phrase I hear as a coach. All I can tell you is that my practice receives more and more calls around burnout, fortunately solutions can be found but support from fellow doctors is helpful as people get back to work.
    I would ask you to reflect about just how happy you would be if the next time you fly off for a holiday you knew that your pilot had been flying ten hours a day for the last five days. Don't worry it will never happen because there are clear rules that forbid this. Planes falling out of skies are quantifiably disastrous but wonky diagnosis by fatigued doctors is tougher.
    In the meantime I would suggest a little fellow understanding and communication, instead of shouting abuse at each other from your silos.

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  • I waited and waited. Kept hearing that something had to be done and something would be done about it. Hit 50 and thought I don't believe you anymore. So I left General Practice - and what I left behind became even worse. I guessed right. Simple as that.

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