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Gold, incentives and meh

Four in 10 GPs taking time off for burnout

Exclusive Four in 10 GPs have taken or expect to take time off because of burnout as a result of increasing workloads and intense scrutiny, a Pulse survey has revealed.

The Pulse survey of 602 GPs found that 12% had taken time off in the past 12 months, while 29% thought they would probably need to in the next 12 months.

It is also revealed that 45% said that staff members in their practice had taken time off in the past 12 months.

Respondents said that heavy workloads and intense scrutiny from regulators and the media were to blame for the onset of burnout.  

Commenting on the results, the GPC said workload was leading to a self-perpetuating cycle, in which GPs suffering from burnout are forced to take time off, passing the burden on to other GPs.

Following a Pulse campaign, NHS England agreed in May to fund ‘high quality’ occupational services for all GPs in England, having initially only agreed to fund services for GPs ‘where there are concerns about performance’.

However, it has not released details about the scheme, which are expected shortly.

A similar survey last year revealed that 9% of GPs had taken time off as a result of stress.

These figures mirror recent findings from the BMA tracker survey, which shows that GP morale is declining even further than last year, with three-quarters of GPs reporting unmanageable or unsustainable workloads.

Dr Raj Thakkar, a GP and clinical commissioning director at NHS Chiltern CCG, said practice colleagues had to take time off because of stress.

He said: ‘Medicine is highly oppressive, with CQC, scrutiny in the newspapers, unrealistic expectations and other agencies putting hard-working doctors under the microscope. All this is on top of working a lot more for a lot less. Is there any wonder there is a recruitment crisis?’

Dr Zishan Syed, a locum GP, said: ‘GPs are subject to terrible pressure and expectations on a workforce that is frankly exhausted.

‘A huge source of stress for doctors is fear of litigation and investigations from their local authorities or other regulatory authorities such as the GMC, sometimes simultaneously.

‘It seems sometimes that such investigations have already established a verdict of the doctor being guilty before hearing his/her perspective. Indemnity organisations continue to ask for huge sums of money, but some doctors have been dropped at the most critical points of their cases by their indemnity organisations, to whom they have been faithfully paying indemnity fees.’

GPC chair Dr Chaand Nagpaul said: ‘These are extremely worrying figures that mirror the base reality of GPs up and down the UK. Even more concerning is the ripple effect of those doctors who take time off due to sickness on an already overstretched GP workforce, resulting in greater stress on those GPs remaining. We need to ensure that we take measures right from government through to local commissioning policies that manage the pressures on GP workload.’

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Readers' comments (43)

  • Yep, all sounds familiar, been there & done all of that. I was forced to make the personal decision to go 1/2 time recently, for the sake of my health.

    The future of GP is salaried or locuming for most of us I fear.

    Partner for nearly 18 years.

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  • The counsellor that I saw when I was suffering from burnout, depression and stress asked me one question.

    "Why do you continue to do this?"

    As I could not answer that question. Made arrangements to leave. She ( with an apology for breaching her codes) sent me a watsapp message of congratulations when I changed my status to retired.

    People who take time out to think, get advice, and recover are unlikely to re-enter the workforce with the same commitment. They will either reduce their hours or leave.

    Partner over 20 years, trainer.

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  • All this regulation has come in with little evidence base to support it. Despite all the scrutiny, litigation costs have doubled by a legal system looking to maximise profit over care. No wonder people are burning out. http://www.theguardian.com/society/2014/dec/13/nhs-litigation-claims-double-under-coalition
    There are way too many people making money at the expense of GPs and patients. This is harmful and needs to be reigned in.

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  • This certainly applies to Practice staff too, especially Practice Manager's .....just look around your local patch and see how many have left or gone sick in the last year... It is very worrying when groups of Managers come together and all say...'we can't cope anymore!' Workloads for all Practice staff are unsustainable and we only need a bad winter to see a potential meltdown

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  • its actually so sad to see a workforce with such low morale. It also makes me frustrated and very angry - that we're treated so badly by the DoH and that we are simply not valued.

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  • It is a wonder that 100%of doctors do not suffer burnout because increasing workloads and intense scrutiny, Doctors are caught between devil and deep blue sea .Follow PCT'and NHS instructions to detriment of their patients whom they are sworn to serve or face the axe.Prof Brian Jarman bmj 2012345;e8239 and Prof Michael Hands in BMJ 2013;346;f209 have pointed out the dilemna facing racticing conscientuos doctors.Yet The GMC and all regularity bodies have not sorted this out

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  • Interesting news from Poland where 6000 GPs belonging to ZP ( Zielonogorskie Poruz.) Agreement have refused to refresh Contracts with the government and formed a private company 'Medical Concept' which will now be offering insurance packets to individuals and companies starting 2015.
    Wonder whether that sort of thing could be possible in UK and whether there is enough cohesion amongst GPs to get together on that scale.

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  • Got out taking VER 18 months early after 30 years as a partner. Practice Manager crashed & burned soon after I left. RIP General Practice........

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  • To be honest, although working 50+ hours is tough, I can manage this.

    It's all the relentless crap that comes with it - media bashing, CQC/GMC/CCG over regulation, unreasonable demands from patients, secondary care with largely junior clinicians pushing increasing work to primary care etc etc. This combined with falling income makes me want to quit - unfortunately I've got another 26 years to go.......

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  • Very sad Anonymous GP partner/trainer to see u go; you are the last group we should be losing - how to generate more GPs w/o trainers? Can't say i blame you tho.
    Recruitment figures shud be interesting this yr!

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  • It begs the question of how the other 60% avoid burnout

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  • I was just saying to Jeremy Hunt the other day as I was polishing my pebble thick glasses:"Jazza- what a wizzo way to close the NHS GP crap shoot whilst all the time washing your hands and being able to blame those nasty doctor shits for being too greedy. Anyone I knew at school who got into medical school deserves to burn like Rome...Ah bless you Jazza- that's a nasty sneeze, keep it to yourself, won't be long and you won't be able to afford private insurance or find a useful antibiotic either, what fun we're going to have then whe.he.he.he!!"

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  • Really, though, are we Independent Contractors or not? If we truly are, then the fault lies with us surely.
    If I asked a Contractor to build a house for £50000 and he wanted £75000 because that was he needed to make it worthwhile, he would walk away. End of. No whingeing or moaning. Just turn on your heel and leave.
    So, while Chand and the GPC bemoans our fate, the fault lies squarely with them that the Contract they have negotiated causes 40% burnout, GP trainers to leave and very few altruistic folks wishing to join.
    They say their hands are tied, or the DOH holds all the aces and so on. They write to The Mail for help.
    How come they have not balloted the profession as to direction of travel ? What minimum payments we need to stay? Do we wish to stay at all? Do the majority wish to put up with this bullying DOH/ CQC etc? Do we wish to resign en masse? No body knows if this is what most GPs wish. But 40% burn out is cause for concern.
    I am a GP for 30+ years and I am beginning to find the whole thing almost impossible.
    It is the joy of most of the patients and the sheer magic of medicine that keeps me. I dare say that if asked most GPs might wish to leave like dentists.
    It is baffling in this horror that the GPC has not sent out one survey.

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  • The next 2 weeks are going to be very interesting.

    The NHS has an end of days feel to it at the moment.

    There is no Plan B. This is going to cost the government dearly.

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  • After 25 years with LMS my granddad got a silver watch and a certificate of appreciation . 25 years with NHS increased pension contribution , decreased pension and cessation of seniority payments . With thanks like this everyone will look for the exits .

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  • We may be 'independent' contractors but we work for a monopoly employer. This was a fudge created in 1948 and like so many post war compromises, now looks to be an anachronism.

    If we were truly independent we would be able to sell goodwill and have limited liability. We wouldn't be constantly inspected and messed around by the government of the day. It is time for the GPC to cut the NHS umbilical cord and allow us grow primary care from strength to strength rather than strangle us with red tape.

    With near infinite demand, healthcare could totally transform our economy and unlike manufacturing is something we still lead the world in. All it needs is for government to press the growth button.

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  • What about the various schemes set up to support GPs? are they not being accessed soon enough or not at all?...Is it a good idea to mix and match roles .those who sit on cttees etc seem to be able to take on several roles as well as practice, maybe this option should be spread out more to give a break from the grind.

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  • It is a similar situation to Dorothy's character in the Wizard of Oz. She had always possessed the power to get home to Kansas all along. All that she needed to do was click her shoes together and say " there is no place like home". GP's as individuals are weak but as a collective group they hold immense power but they have chosen not to utilise this so far. Collectively we all have the power to change this very quickly but they need unity and leadership.

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  • Yep all sounds familiar.
    I'm leaving my (excellent) practice after 30 yrs which is sad but I can't put up with crap anymore. Locum sessions next to top up the pension.
    I fear for my remaining partners but have to look after my mental health, and as I'm senior partner I deserve to have the privilege of leaving first.

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  • Such a lot of dark thoughts and abject misery!
    If life in practice is as hard as many are making out then they aren't doing it right.

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  • I am 56, I am struggling to work at this pace. I have recently reduced my hours in an attempt to survive until retirement but am still feeling overwhelmed. I constantly worry that I may not be providing an acceptable level of care due to the pressures placed upon us.

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  • Guess what...the guys in power don't give a s**t

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  • Re anonymous at 9.35pm. Seek some help. Contact your LMC. It's not your fault.

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  • I still care massively about my clinical work and my patients. But as far as all the other BS like appraisal, CQC, inspections etc is concerned I do not give a s...anymore. If anyone can get a better service than with my practice then good on them, go somewhere else. However, don't expect me to feel
    Responsible for the cuts - sorry, efficiency savings- our rulers have imposed.
    Deeply reject us as part ofCCGs taking responsibility for the crap others dished out for our patients. That's the first role we should all reject. Let's make it clear for anyone whose side we're on- our patients. Getting rid of this Jekyll and Hyde existence will enhance our job satisfaction.

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  • I'm a junior doctor wondering wether to do GP or not and this scares me to a certain extent!! But what I don't get, and maybe GPs could answer, is if there is a shortage and recruitment is low why there isn't any fundamental changes. Should I bite the bullet and try to enter hospital medicine.

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  • Dear Ghanshyam,

    You are witnessing the end of a cycle. The current 'Independent Contractor' model of general practice is dying. But general practice is still a fantastic profession and there will be a range of salaried opportunities on offer in years to come. Remuneration will improve - due to local and international competition for your skills. This will prove a lot more expensive for the Government, but that is not your problem.

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  • @11.02:
    As a partner and trainer I can honestly answer that at this point in time I Would not enter GP unless you are seriously planning to emigrate after your VTS.
    Training in the UK is excellent. The 40 years after will be TOUGH!!!!!
    There is no silver lining on the horizon. All parties are hellbound to balance the budget which all experts agree can only be done by restricting public sector pay, mainly of the ones 'with the highest incomes' - you'll be one of those in their eyes, regardless that you'll pay 30% pension contributions as a partner.
    Don't do it. Choose a specialty which gives you the option of a good private practice income.

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  • Disagree with 11.13. This is not a normal market where a lack of skills should cause a rise in value for these skills. There is almost a monopoly supplier of funding, the Government. A capping of funding will mean incomes cannot rise as they will not

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  • Sorry , doing this on the phone.
    Public services will not pay more for GPs and Partnerships will rather cut services and posts than pay salaried GPs more than they earn themselves.
    Being a Consultant means you can boost your income, by non NHS work which is where the real
    Money will come from in the future. The big plan of politicians is to shrink the NHS, but GPs are solely reliant on their NHS income - unlike consultants.
    Don't get me wrong, you'll have to be a much better doctor to be a GP these days than a consultant who's possibly only specialising on pushing a camera or two up
    Someone's orifices, but don't expect to be rewarded for it.

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  • Una Coales. Retired NHS GP.

    Don't enter GP land. The future is 'enslaved' salaried GPs..http://www.medscape.com/viewarticle/836217_2 'There is sometimes too much emphasis on the bottom line by employers and insurance companies. And also at times too many oppressive rules in clinics, hospitals, state regulations, etc.'

    If you must remain a GP in the UK, try the independent practice model set up by family physician Dr Pamela Wible which has spread across America in which she charges patients directly at affordable rates.

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  • Una.what are 'affordable rates'?.who sets them?

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  • Una Coales. Retired NHS GP.

    @4:27 pm...same as affordable commercial rates for plumbers, electricians, dentists, counsellors, hair stylists, tax accountants, real estate agents, lawyers, and certainly cheaper than private hospital consultants.

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  • Thank you for all your responses. After doing 15 hours today in hospital as a junior makes GP land a very nice proposition. Yes pay is sacrificed but there is control over where I work, what days I work, and quick progression.
    With private practice I don't know how much the extra cash can really improve your life? Isn't there much of a market for private GP work?
    On the negative you will have to live with the day to day job of course. I've heard a lot of GPs say not to do it, including my own GP.

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  • I am a GP partner and trainer and have left . Thank goodness I'm out of it

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  • Best thing I did . Took 1 month off and was 24 hr a day with a wife I loved over 35 years but never spent so much time as work demanded more than a working week

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  • Gosh! I shall I'll send my future wife an avid email of warning. maybe in the future I can download my consciousness into a computer so i spend time at home. Or send it to work...hmmm.

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  • GP trainer and partner 20 years - just left as has destroyed me and my family

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  • Just adding my voice. 50 years old, a GP for almost half my life, always seen myself as a doctor first and prided myself on being able to maintain a work-life balance while being prepared to stretch the boundaries of duty for my patients. I've never had any mental health problems - I've never had any time off sick at all except for a few weeks when I was needed to look after one of my parents. Until a couple of years ago, I was insistent that I couldn't imagine ever wanting to retire from general practice.

    And I'm now having to get my head round the fact that I've got a severe dose of burnout, with a full house on the questionnaire on the BMA website and a high PHQ-9 score for depression.

    It's a relief to have a unifying explanation for the physical and cognitive symptoms, the inability to "pull myself together" and do everything that's required of me at work, and the nagging and completely unfair belief that I'm worthless and my family only value me as a breadwinner.

    I'm hoping that the penny has dropped in time for me to resolve the situation, take time out to recover (but then I worry about my partners - they're good, dedicated doctors and at least one of them is also close to the brink, and locums are thin on the ground in this corner of the country) and find that the profession for which I used to be full of enthusiasm is still there.

    I never thought it would happen to me. I suppose nobody ever does think it will happen to them.

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  • Have worked with GPS 25 years burnout now 1 in 10 treatment works but is not available as it is outsourced not individualised NHS England are axing service for GPS in South West despite the fact it will cost them to do so in favour of outsourcing to so called qualified providers to meet political dogma not HEALTH CARE

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  • I've been a partner for 20years, and an F2 trainer. Crashed and burned 3 years ago, had six months off then returned on only four sessions a week. I'd never had time off before, but that was the only way I could return. Would I take early retirement- hell yes, but recent letter from NHS pensions says I need to work to 67, doing this job? Would I miss my patients and colleagues- dreadfully. Does this make me a co-dependant propping up a failing system to feel good about myself? And is that what the "Powers that Be" are relying on?

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  • I 'm coming to the end of ST2 year in general practice and I too have had enough, already. Working 60+ hours a month more than contracted in my hospital job has reduced me to something akin to the walking dead. I loved my ST1 placement in GP but the prospect of working in medicine full stop until retirement is too much to bear. I will be resigning tomorrow. Sad times but feel liberated having come to my decision.

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  • NHS England can minimise the effects of workload by taking the following steps immediately:
    1) Taking on the Indemnity of all GPs. The Trusts indemnify doctors. Many "Older GPs" will be happy to return to part time working at least.
    2) Fund Occupational Health and make it easily accessible to all GPs.
    3) Fund educational courses to reduce stresses and increase wellness in GPs. Unless these immediate steps are taken, one cannot reverse the rapidly escalating trend of workforce crisis.

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  • Yep, off long term sick - who knows if I will return to running a business & seeing pts?
    Still don't feel recovered.
    Therapist talks about secondary ( vicarious) trauma from years spent working in NHS.
    Now intensity of this increases due to complaints culture & over regulation.
    He may have a point.
    What sort of culture crucifies people who want to help others?
    Resilience ? Pah ! Tried that & look where it has got me.

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