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Preventing suicide amongst GPs needs a system-wide change

Dr Clare Gerada and Dr Kailash Chand

Dr Kailash Chand

 

12 prof clare gerada

 

General practitioners are at the front line of delivering healthcare. More than one million times a day, they have to contain the pain, suffering and despair of their patients. More than many others in the medical profession, they have to face the failures of service provision – be that in healthcare as their patients have to wait longer for operations or cancer treatment, or in social care as many patients find they simply cannot afford the basics to sustain independent living, or failures in housing policy, as lack of affordable housing means increasing numbers of people are forced to ‘sofa-surf’ or sadly sleep in temporary hostels or become street dwellers.

General practitioners are, therefore, working in an environment where no matter how hard they try, they simply cannot make good the failures of funding and decades of lack of investment in provision.

General practitioners are frequently portrayed as both the saviours (as being able to reduce costs by keeping patients out of hospital) and the scapegoats (accused of being profligate with their use of resources) of the NHS, when all they want to do is their job.

Uncertainties about their future, including how to fund their premises; increasing costs of staff; failure to recruit new GPs; demands from CQC; forced practice mergers; and the rising culture of complaints adds to the pressures GPs have to deal with. It is hardly surprising, therefore, that increasing numbers of GPs are becoming depressed and sadly, some of these doctors are taking their own lives. The GP Lucy Henshall recently gave a resounding speech at the LMC Conference in Belfast, where she highlighted the rise in mental illness amongst GPs, and sadly the increasing numbers who are taking their own life.

She and the LMC conference called for action to prevent GPs killing themselves.

GPs are too precious to lose for a systematic failure

Of course, providing timely care for GPs who are depressed, burnt out or having dark thoughts is important – and fortunately the NHS General Practitioner Health Service is now accessible to all GPs in England. 

But suicide prevention requires more than dealing with those at the end of their tether and contemplating death. It requires action to improve the working lives and reduce the risk of suicide for all GPs. This needs practical action. Longer time with their patients (at least 15 minutes as routine); fewer patient contacts per week (maximum of 60 patients contacts per week); more time for reflection and supervision such that they can talk, with their peers, about the emotional impact of their work, and, finally, more control of their working lives, not dictated by the latest unachievable target or guideline.

To remain well, collectively, GPs need to be able to focus on what they do best – provide continuity of care, to a registered population, in the context of their patients’ families and communities.

The solutions are complex, and prevention lies in addressing the systemic causes of stress (related to diminishing resources, increased workload and unachievable demands). We call up the RCGP, BMA and LMC to work together to create a new Charter for GPs, one which addresses their needs along side those of their patients.

GPs are too precious to lose for a systematic failure.

Dr Clare Gerada is Medical Director of the Practitioner Health and GP Health Programme

Dr Kailash Chand is a BMA Council Member and retired GP

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Readers' comments (11)

  • More waffly platitudes.
    GPs cannot be ‘all things to all men’ (i.e. a contract so open that one can approach a GP with any concern under the sun, including non-medical problems, that we have no training for and are not funded for). Then impose a career and livelihood threatening ‘non-evidence based’ regulatory system for failure to provide unreasonable and unrealistic expectations.
    What do you expect this to do to communal morale and psyche?

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  • Cobblers

    Charter for GPs? Sigh. That'll work. Not.

    Face it. We're fuxked.

    I know that is an unhelpful comment but by saying that truth then each one of us can try and make the necessary adjustments to survive.

    Mainly by leaving NHS servitude.

    #thereisanotherway

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  • National Hopeless Service

    And the new contract was an ideal opportunity to address at least some of these issues but achieved nothing. The BMA no longer serves GPs as people just numbers that do a job.

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  • Dumping Appraisal and Revalidation would hugely improve GP morale, free up the equivalent of 1000 full time GPs, and save £millions.

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  • Have you seen the guardian article about how junior doctors are treated?

    Over the last few years I've come to the conclusion that the NHS basically runs on abusing it's staff. More unfunded work anyone? Enforced pension tax?

    I wouldn't reccomend a patient stays in an abusive relationship so why do we? I'm off overseas, I hope those left behind get treated better but suspect unless we grow a collective spine it will never happen.

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  • We are trained as clinicians not managers and should be free from managing managers, other clinicians and endless paperwork, admin and the constant micromanagement of us.
    I long for the days when we only heard from the old FHSA s once we resigtered as a GP principal then once a month by way of a statement of claims and payment
    I myself have been very depressed after huge stresses in the practice caused by unpleasant individuals, shortage of funding, lack of clinicians, going back to full time for a year before surrendering the GMS contract
    I now work as a love and just see patients.
    I recommend the liberation this brings but sadly GP’s working lives could be made much more sustainable with more pay and support.
    We need as doctors to unite in firstly setting safe standards of care and giving back contracts where we can not implement them
    Pay is secondary but still important
    I would rather be alive than the alternative

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  • I hope things are better now Anonymousgp

    My stressed are

    1 Overload at work
    2 CQC
    3 Financial insecurities with the practice
    4 Lack of clinicians
    5 Uncertain future
    6 Complaints

    Revalidation is an irritation and time consuming--but I don't get stressed about it. Sick and dying patients don't stress me. That's what I want to do--help them. Rude and obnoxious patients are stressful. Having all work dumped at my feet is not pleasant.

    OOHs work is fine. Its the nonsense of being a Partner that is so dreadful. Getting out is expensive due to tax implications and liabilities built up within the practice---otherwise I too would be a locust.

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  • The only thing I can suggest is that you ignore guidelines and most preventative medicine and practice clinically and using your judgement. The trouble is that younger GPS have grown up with guidelines and some cannot function without them.

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  • 15 minute appointments and a maximum of 60 patients a week! what planet are you living on...
    that's like being a geriatrician and has nothing to do with traditional general practice.
    sorry but no thanks.

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  • the NHS is a bully and functions on emotional blackmail of its staff to work for low pay and poor working conditions. always has done from day 1. people put up with it for a decent pension at the end and the feeling of a job well done helping people. now the pension has gone and patients complain rather than appreciating what they have been given, often at reduced costs compared to other people on the planet, there is now no incentive to work in it. The NHS was always run on unpaid overtime by all its staff - which is why private companies can never make a profit on nhs contracts - the UK could never afford the actually pay amounts that should have been paid to its staff over the past 70 years - it has always been run on a massive freebie which is why it has worked up till now. The NHS and this country owes NHS staff billions of pounds in unpaid overtime over the past 70 years. when this is ignored by successive governments and staff are pushed to their limits they just leave and no one wants to replace them. you can replace them with physios and pharmacists and the like but the inherent problem will remain and they will, eventually, leave too. to help staff cope you need to change the ethos of the NHS culture, pay for the work done and if this means cutting non essential services to cover the costs then that should be done too. Patients don't go to see a machine, they go to see a human being. The NHS cannot function without people. if there are no staff there is no NHS.

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