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At the heart of general practice since 1960

A body blow to a profession on the brink of burnout

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For much of the last year, Pulse has been campaigning to raise awareness about rising levels of stress and exhaustion among GPs. Our Battling Burnout campaign has shone a light on a subject which even GPs often find it hard to talk about.

As well as seeking to publicise the problem, we made two very simple demands: that there be better monitoring of GP workload, and that GPs who need it be offered much more consistent occupational health support, nationwide and taxpayer-funded.

So the news today that NHS England has ruled out universal funding of occupational health services, and that the review it has conducted over the past few months will propose providing support only where performance concerns have already been raised, comes as a real blow. True, GPs in England will no longer be subject to the postcode lottery of support the review identified - but the amount of support on offer will be levelled down, not up. 

It seems the story we reported last month from Cleveland, where an NHS England local area team had pulled funding from all occupational health support not directly linked to a formal performance review, was sadly prescient. 

At the time, local GPC representative Dr Bill Beeby pointed out that pre-emptive support was designed to prevent GPs from ‘going over the edge’, and warned: ‘The problem is, when it becomes a performance issue… it’s already too late’. Unfortunately, that argument appears to have made little headway with the powers that be at Quarry House.

Add your name to Pulse’s letter to NHS England over funding for occupational health services

There are two reasons why NHS England’s decision today is a misguided one.

First, in purely practical terms, it is short-sighted. Pulse’s campaign has established beyond all doubt that burnout is a pressing problem for a profession already in the grip of a recruitment crisis.

Our asssessment of almost 1,800 GPs using the validated Maslach Burnout Inventory tool back in June found that as many as 43% of GPs were at very high risk of developing burnout. A separate, multi-topic survey found one in 11 GPs has taken time off work due to stress or burnout within the past 12 months. The Practitioner Health Programme, the largest service in Europe for doctors with health concerns, has seen the number of new doctors and dentists seeking help more than triple in the past four years. Even ministers acknowledge that stress is forcing GPs out of the profession.

Burnout, then, is a very real problem, and one that is costing the NHS in strictly financial terms. We have yet to see any impact assessment that NHS England conducted as it made its decision, but given the cost of training a GP - and the current shortage of them - it seems hard to believe that pre-emptive occupational health support isn’t a cost-effective investment.

But even regardless of the cost-benefit argument, many GPs will feel that today’s decision is simply the wrong thing to do, and sends a bleak message to hard-working doctors who in many cases have literally given the best years of their lives to an apparently ungrateful NHS. We talk of a ‘military covenant’, acknowledging that the nation has a duty of care to its soldiers and servicemen, a duty of care which includes paying towards healthcare costs for physical or mental injuries. Working as a GP is obviously very different from serving in Afghanistan, but there is an argument that a similar principle should apply - that we should have a ‘medical covenant’, if you like, whereby the NHS should take care of its own.

Although NHS England’s review has recommended against routinely funding occupational health services, we are told that the recommendation is a ‘proposal’, with a final, formal decision yet to follow. Managers there should take a long hard look at the decision - both its practical implications and the message that it sends to dedicated doctors working for the NHS - and they should reconsider. If not, it will appear all the concern, alarm and anger over the growing problem of GP burnout has fallen on deaf ears.

Steve Nowottny is the editor of Pulse. You can email him at stevenowottny@cogora.com or follow him on Twitter @stevenowottny. 

Readers' comments (5)

  • Can they do that? Is http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4006976 no longer current?

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  • That link didn't appear clearly. Try this:

    http://tinyurl.com/qynjtxz

    The full citation is:

    Department of Health. The provision of occupational health and safety services for general medical practitioners and their staff. London: Department of Health, 2001 (May 2001); 1-32 (http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4006976).

    The foreword states:

    "The primary care work force represents a substantial part of total NHS staffing. It has long been an aspiration to make occupational health services universally available to all who are engaged in NHS health care, including general practitioners and their staff, as well as those in hospital and community trusts.

    "The provision of these services will, by improving the health and environment of the primary care workforce, ensure that General Practitioners and their staff make the best possible contribution, both individually and collectively, to improving health and patient care in primary care.

    "That is why the Government announced in the NHS Plan that Occupational Health services would be extended to General Practitioners and their Staff from 1st April 2001.

    "We are therefore delighted to bring you this guidance which gives details on what Health Authorities need to commission, funded through additional allocations to their budgets to provide these services. This guidance is the culmination of many months of work by the Department of Health, the British Medical Association’s Occupational Health and General Practitioners Committees, the Faculty of Occupational Medicine, the Society of Occupational Medicine, the Royal College of General Practitioners, the Association of National Health Occupational Physicians and the Royal College of Nursing. It recognises in the most practical way the commitment of the NHS to its staff and through them to the people it serves.

    "No doubt lessons will be learnt as this most important project goes forward and occupational health services in primary care are developed. We welcome this beginning and look forward to the future."

    While Health Authorities have long since been abolished the duties imposed on them were transferred first to PCTs, and then to CCGs and NHS England. So, as I understand it, if NHS England decides to cease funding occupational health services for primary care, it will be in breach of its duty to do so.

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  • Peter,
    Have you pointed this out to NHS England?

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  • I have already sent Dr David Geddes at DH a link to this DH Publication. In Devon and Cornwall we have had a very comprehensive service for about 20 years. Our evidence confirms what other services in different parts of the country have also found that with appropriate OH and psychotherapeutic help over 80% of GPs who use our service are able to continue in work for the NHS. It is impossible to prove a negative but even if we are able to prevent 2 suspensions or GMC investigations each year then the service more than pays for itself. And that ignores the avoidance of the human cost to the individual doctors who seek help.

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  • GP stress and the risks of burnout are not new, but the prevalence is on the increase. I agree that a nationwide OH service should be a priority for GPs and primary care staff. As well as pushing for this I have done something practical about it. I have been running a Mindfulness Based Stress Reduction course for GPs with Dr Mike Scanlan as web based seminars (webinars) recorded and accessible for those not able to attend the live training sessions. More info at www.webinarsforgps.com/calendar . We will be repeating this course, with some financial support from the local Northants LMC

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