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GPs go forth

This is it. From now on, I choose life

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I am neither religious nor spiritual. Yet it is the Serenity Prayer I refer to most in times of need: ‘God, grant me the serenity to accept the things I cannot change, courage to change the things I can change, and wisdom to know the difference.’

Although I have saved my sanity, I feel huge guilt

As an educator who has indulged in extensive navel gazing, I am aware of my strengths. I know that courage, but not serenity, is one of them. So I’ve spent the past nine years as a partner trying to be courageous and change things. I’ve tried to manage patients by ensuring consistent practice policies. I’ve tried to manage demand by discouraging dependency and fostering a culture of self-care. I’ve tried to manage recruitment by diversifying the workforce and creating a supportive training environment.

But this is a battle where I am faced with weapons of mass destruction and all I have is my bow and arrow. Occasionally, my arrow may land on target, but I am exposed to a lethal and toxic environment, where eating, breathing and sleeping my struggles becomes the norm. A place where I daren’t switch off for fear of being unable to switch back on. A cocoon that may appear warm and comfortable on the outside, but is slowly destroying me on the inside.

So, because I was never going to do serenity, I moved away from courage and on to wisdom. The wisdom to realise that the contract was making me drained, cynical and depleting me of joy. And I used the courage to turn my back on it and walk away.

By the time you read this, I will no longer be a partner. The role that 10 years ago was being pursued by hundreds of applicants and I felt so proud to achieve. The role I moved cross country to undertake because it was almost impossible to secure a partnership in the South-East in 2006. In stark contrast, our practice now has unfilled vacancies for three whole-time-equivalent GPs and I know we are not alone.

So in spite of rationalising, innovating and merging, I was unable to shake off the burden I felt on a daily basis. My pessimism was malignant and insomnia the norm, as I lay in bed worrying about my business going under and having to sell my house to pay off the liabilities. There was a nausea that grew over the course of a Sunday evening and I started dreading my job and resenting my patients. The final nail in the coffin was the stark realisation that I felt anger instead of empathy when a GP colleague went off sick. That was the trigger for me to complete a burnout questionnaire; the results were so disturbing I gave notice of my partnership resignation that very evening.

Within a few weeks, people noticed how much more relaxed I looked. My brain started filling with creativity instead of anxiety. Yet although I have saved my sanity, I feel huge guilt for turning my back on the independent contractor status that I still believe to be the most efficient way of delivering primary care.

But I’ve chosen my sanity and I’ve chosen my family. Most of all, I’ve chosen life. Because life is too short and too precious to be a scapegoat for the NHS.

Dr Shaba Nabi is a GP trainer in Bristol

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Readers' comments (53)

  • Samuel Jackson

    Beautiful writing. I wish I could write with such intensity and such honesty. Thank you

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  • No need to feelguilty Shaba. Good luck with the next phase of your career.

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  • Great piece of work, thank you for your honesty and prespective. We are all to often overburdened, underresourced and with unreasonable expectations. Looking after our work life balance is so important.

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  • It is time that the GP Partnership model comes to an end in the UK. It is not fit for purpose any more. Payment per consultation and removing practice boundaries is the only best alternative.

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  • Please reflect and write on how you are feeling in one year and share that with us.
    Only when you get away will the burn out that permeates this writing shine through even more acutely.
    I think it's is great that you have made a decision but I feel so concerned that for so many of us the decision is just that: to walk away.
    And this is a symptom of a system that is unsustainable for the majority
    Take care x

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  • I'm posting from New Zealand, where we are paid up front per consult by our patients. The consult is 15m, but if it turns to custard and you need to go longer, folk wait. We are desperate for good rural gps, loosing a cohort of 25-40yr olds to specialist jobs when student loans forced med skool grads to ditch gp for higher pay. You won't always feel so negative. Come practice in the sun where patients still say thankyou, and heal ❤️🌞🌻🏖

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  • Thanks Shabi, good honest effective writing.

    Its boiling frog syndrome. Sometimes you are aware its getting to hot and jump out, sometimes you do not realise its hot and die in the boiling water. Some frogs can tolerate the really hot water and keep going. Its a variable picture and can be difficult to know what type of frog you are. Self awareness tends to go when you get chronically stressed or ill with depression/anxiety and you often stay in the water because you lack the capacity to think clearly and take action. If you can hack it fine, if not take a deep breath and jump out because you have great skills and there is lots that you can do which is rewarding, fun and pays the same/more. Look up, look around, actually its a big wide world out there with lots of new stuff going on more in tune with these times than the single Practice/Partnership model which the government clearly do not support.

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  • Vinci Ho

    Life goes on
    All the best

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  • Pev,Nabi, Copperfield all say the same thing. GP land is awful for many. But there are practices with extra funding for patients who feel fine.
    Today's news on Sunderland failing children's services gets a new boss, but hey MORE money and staff. Absurd. If they had done that first, it would not have failed.
    Same here in GP land. All the Trusts are in the red, but get bailed out.
    We GPs do not. We just keep on taking pay cuts.
    Pay per item has fallen 55% in 10 years. [ 25% less absolute pay for a 60% increase in workload].
    Only Maureen thinks there has been no better time to be a GP.

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