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Independents' Day

Patient safety at risk unless NHS creates 'right working environment for GPs'

Burnout in doctors results in an increase in medical errors, reduced quality of patient care, and lower patient satisfaction, researchers have found. 

The analysis by researchers from the universities of Manchester, Keele and Southampton, yet to be published, concludes that 'patient safety could be at risk' unless the structural reasons behind burnout are tackled. 

Pulse has previously reported that GP burnout is continuing to increase, while NHS England has set up a service to support burnt out GPs.

However, the researchers said that stress management programmes are less effective than changing GPs' working environment. 

The study looked at data from 42 previous studies to analyse associations between distress in physicians in the US and three core outcomes of patient safety incidents, poor quality of care and patient satisfaction.

The main analyses were based on 3,332 physicians from primary care, hospital and specialist areas. But researchers then focused specifically on primary care doctors and found the results were exactly the same.

Dr Maria Panagioti, lead author of the study and senior research fellow in health services and primary care at the University of Manchester, warned that the impact of burn out on patient safety and as an organisational problem has ‘not received much attention up to now’ and more research is needed in these ‘two key areas’.

She said: ‘The message from these findings is clear. If we want to retain safe and professionally competent NHS doctors in the very demanding UK primary care environment, we need to support their mental and physical health by creating the right working environment for them.

‘Efforts need to be focused on finding appropriate ways of reaching doctors who work in stressful environments to ensure their wellbeing is taken care of. If we don’t patient safety could be at risk.’

It follows the team’s previous research, published in the Journal of the American Medical Association, which analysed data from 1550 doctors to show that organisation-directed measures targeting the working environment are more effective at reducing burnout than interventions that target individuals, such as stress management programmes and mindfulness.

Maria Panagioti added: ‘In the UK many GPs have said that excessive work demands and system pressure is the main cause of their prolonged stress.

‘Organisation-wide initiatives for fostering communications between members of the health care team, and cultivating a sense of teamwork and job control are likely to be the most effective approaches in reducing burnout.’

Pulse's Battling Burnout campaign led to NHS England providing substantial funding for a new national service to support GPs’ mental health, as part of the General Practice Five Year View.

In the first four months since its launch in January, over 500 GPs suffering from conditions such as anxiety, depression and post-traumatic stress disorder, had sought help under the new NHS programme.

Dr Panagioti said: ‘The new national GP service is definitely a positive initiative but it is too early to evaluate its potential benefits.’



Readers' comments (15)

  • Reduce demand - that means government and everyone else including rcgp - and it seems the bma - stop saying gp best placed/see gp
    CCGs and health boards MUST enforce the contract and stop hospitals dumping on GP....and GPs must stop taking on work because it is best for the patient - tired burnout GPs aren't safe and arent in the Patients interest

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  • Let's face facts. We have a pointless Royal College who serve themselves, and a DOH who are actively trying to break us all so we quit the NHS and do their dirty work for them. I suspect behind closed doors they really must be thinking "what on Earth do we have to do to finish them off. How much more are they willing to take?". They've piled on the work, cut the income and now forcing up the indemnity and we still go in each day….

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  • Vinci Ho

    Take this research evidence to the health secretary. Do you think he will be interested ? Certainly not the cherry he would like to pick .
    Once again , Sarah Wollaston, where are you? (My recommendation to you as always , quit your party).

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  • AlanAlmond

    Vinci, The health secretly only takes an interest in research papers that support his political position. He won't be reading this one.

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  • Maverick

    Having personally experienced burnout, I really empathise with any practising GP reading this article thinking "how much more can I take" or "when will DOH, RCGP, NHSE etc etc recognise my plight and help". Your work / life balance is in ruins. You can't sleep, you drink too much and sit on your back step at three o'clock in the morning thinking your family would be better off if you were dead. Patient demand is overwhelming, work from hospitals / secondary care is spiralling out of control, negative media reporting is demoralising, government abuse is rife, indemnity fees crippling...and on and on. The answer is simple. Help is not coming. This is all part of the government's plan to destroy General Practice and replace it with nothing of any value. Such a shame really but never mind. At least the RCGP will be disbanded as there's no need for a Royal College of nobody. Royal College of health care assistants, physicians assistants, pharmacists and dog walkers and those keen on colouring in with crayons. Just be sure that when the service is gone it will be the politicians and not GPs who get the blame. I'm sure that will happen... NOT. Daily Mail calls for urgent recall of GPs. UK health service in tatters...
    If you are a qualified doctor considering a career in General Practice....don't. If you are a practicing GP and you have any opportunity to get out... do it now. You owe it to yourselves, your family, your friends and all who are dear to you. In years to come we will have a primary care service but nothing resembling what we have today. GPs will be gone. The politicians responsible for the destruction of the NHS will be forgotten. You don't know what you had until its gone. Good luck and go well.

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  • Until there is a daily cap on workload the job is unsustainable and unsafe.
    We have been screaming this ,but no one is listening - because we have carried on out of sense of duty.
    We don't have time to be safe then we are persecuted for making a mistake - the vicious circle of General Practice.

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  • Maverick

    .... "sit on your back step at three o'clock in the morning thinking your family would be better off if you were dead."


    This happens. The only scary thing is that thinking like this feels so RATIONAL.


    If only all GPs would change their lives before crashing as I did.

    Mav sums it up perfectly.

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  • This is a really important thoughts today are with the thousands of practices up and down the country (I am on call today as well!) who are working very hard in difficult circumstances with an under-resourced general practice and fragmented rest of NHS (whilst the promising transformation/ integration initiatives take time to embed).

    There has to be a better way forward. I really care about this issue. Burnout prevention is really important and a key skill that should be taught from medical schools onwards. I know some GPs and practices have found really good ways of managing these issues. Please send me any examples and or submit to bright ideas at RCGP.

    In the mean time these resources are very helpful.There are other similar resources.

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  • Maverick is right. We have lost the battle. Get out while you have health, a family and the pension before the job and in the latter case the government take it away. The RCGP , BMA and the NHS have all failed us.

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  • Mayur, the key point of the article is 'treat the cause, not the symptom'.

    The GP Forward View is failing because it doesn't address this point. There is a near 8% annual wastage rate of GPs and no-one has yet asked why that is? Until we address the causes of GPs burning out and leaving the profession the workforce will continue to shrink and more practices will fail.

    More resources, less workload dumping, reimbursed indemnity, less bureaucracy and regulation (GMC, CQC etc.). All seemingly unpalatable to NHSE, but vital if general practice is to survive.

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  • Retired GP, I could not agree more, ie. to treat the causes. thank you. Your list is very helpful and I will use it, if I may. clear that multifaceted strategy and interventions needed all of which take time, but really urgent situation now as we hemorrhage GPs especially the 'last 5'

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  • We are our own worst enemies because we have always selflessly put patients first and try to do the right thing. I did the BMA burnout questionnaire and it came back as high risk so I had a holiday and did it again and the same result. I asked my colleagues to do it and they all came out as high risk and instead of addressing the issue stated the test must be wrong! Didn't like the answer shouldn't have asked the question is the normal response. As a practice we have employed a community pharmacist since without help from NHSE. The Australian RCGP is much more proactive in helping their members who have a much lower workload and have a strap line "I'm not just a GP. I'm your specialist in life" Little wonder colleagues are emigrating. In one way I hope we become fully salaried because then employment law and basic human rights laws will apply. My fear is Maverick (0:48am should have been asleep) makes a very good point about the destruction of NHS Primary care. Backbone of NHS and as Simon Stevens has said no primary care no NHS.

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  • IMO burnout does not exist. Instead we should be calling it what it is - the systematic destruction of primary care and particular GPs. Those who 'burnout' are just fed up of the bullshit and can't take any more.

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  • The clear issue here is a shortage of colouring-in books. Sort it out RCGP so you can get your fellows more knighthoods

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  • In polite response to Mayur:"whilst the promising transformation/ integration initiatives take time to embed". Don't make me laugh. They are not promising, are not meant to save Primary Care and will only serve those who have licked their way to the top of a super practice to spend their "strategic sessions" performance managing the Minions in the consulting rooms on the ground floor. I know who I would like to treat me if I was ill (the Minions...).
    Sorry, but the RCGP spokespeople are now becoming the General Melchetts of primary care.

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