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At the heart of general practice since 1960

Mr Hunt, GPs can take no more

As the prospect of out-of-hours responsibility looms, Pulse’s Battling Burnout campaign highlights the intense pressure the profession is already under, writes editor Steve Nowottny

As soon as we launched our Battling Burnout campaign at Pulse Live last month, it became apparent we had hit a nerve. GPs queued up to take our burnout assessment in person; at the time of going to press, almost 2,000 have now done so online.

The findings of the survey, outlined in our cover story this month, are alarming, with some 43% of respondents reporting a triple whammy of emotional exhaustion, depersonalisation and a low level of personal accomplishment. But it is the comments that make the most harrowing reading: hundreds of individual stories that together paint a depressing picture of ever-increasing workload and stress.

Pulse’s campaign aims to raise awareness of the challenges of a career that has always been uniquely demanding, and lobby for much more consistent monitoring of GP workload and support – taxpayer-funded and nationwide – for those who need it. But the current high levels of burnout are not simply an occupational health issue; they point to a wider problem with the burden on GPs.

In her opinion piece this month RCGP chair Professor Clare Gerada, who as head of the Practitioner Health Programme is well qualified to speak on the subject, argues convincingly that current levels of exhaustion are the result of the sustained pressure year on year on GPs’ workload, pay and morale. In other words, burnout is not just personal: it’s political.

Which brings us to the other big development this month: health secretary Jeremy Hunt’s demand that GPs resume responsibility for out-of-hours care. Despite weeks of unfairly blaming GPs for the pressure on A&E, furious Daily Mail front pages and dark hints about the future of the GP contract, we still don’t know what this will mean in practice. It won’t mean GPs having to personally provide out-of-hours care, we are assured – but it probably will mean more than GPs simply taking responsibility through CCGs. The best guess is that some form of ‘sign-off’ responsibility will be written into the GP contract, but this has yet to be clarified.

What is certain is just how deep GPs’ opposition to taking back responsibility runs. It’s not just the memory of 3am home visits, or the sneaking suspicion that once GPs are contractually responsible they will be roped into shifts as providers of last resort. It’s not just the likelihood of additional administrative work, or the probability that that work will be inadequately resourced, or that the blame-mongers in Westminster and Fleet Street will be given one more stick with which to beat general practice. Above all it’s the fear GPs will be held accountable for yet one more thing – and one more thing over which they have little control.

For many GPs it is this crushing burden of responsibility that is ultimately the greatest source of stress – the intense pressure of making a snap clinical judgment every 10 minutes, the worry of fighting patients’ corner as they navigate the NHS, the nagging fear that that tricky decision they made last week could result in an unwarranted complaint or GMC investigation.

Despite Mr Hunt’s claims to the contrary, GPs are already painfully aware ‘the buck stops with them’. Over the past decade, they have soaked up more and more responsibility, not least through the NHS reforms. But there is a limit to how much they can take. Our findings on burnout suggest that limit has now been reached.

Readers' comments (14)

  • Thank you!
    This article expresses exactly how I feel.
    In addition, every time I see a PHQ9, GAD7, Oxford knee, Oxford hip, CHADS2, visual disability score, START back score etc I want to scream.
    It is so sad, because the patients themselves are mostly lovely.

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  • Hunt and his media friends couldn't care less how far they push us. But, as with most things, time will show things clearly. The A/E crisis won't go away. Changes to our contract won't solve the problem-as we aren't the cause of it-and Hunt will move departments. The Daily Mail will continue banging the war drums-but this time-in a different tune ie that GPs are incompetent and lazy, which is why things have failed. Preying on people's fears and anxieties does indeed make money but there must be more honourable ways to become wealthy.

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  • I agree , this is exactly how I feel.
    I did not do the survey but It reflects well the
    situation for me

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  • This is just music to his ears.You are just telling him what he wants to hear.He wants the NHS to collapse.There is a lot of money to be made from privatisation.

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  • This is every GPs story. Workload pressure, depersonalization, low morale, ever-increasing demands from patients made to believe the NHS is a 5* Rolls-Royce service and a largely clueless MP crushing whats left of us with his insane claims. this Govt. has no idea how much damage it has already done.

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  • There is a clear disconnect between the DOH and the papers on one side who think we do not do enough and need to do more.
    We feel burnout and over worked and anyone who can leave is leaving.
    This is completely our fault. We do not define what enough is. Who can judge if we have no normals ?
    If we define health and safety, for example, as 25 patients and 9 hours per day, then we can say we are over or under worked.
    Nobody accuses lorry drivers or airline pilots of laziness - their health and safety is defined so that the public are safe.
    Equally, I do not wish to be seen by an A+E consultant who has been awake for 80 hours as happens here in North Ireland.
    So, let us stop these arguments and define safety for doctors and thus for patients. Or are we not part of the human race that has the same rights to a work / life balance?

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  • I agree explicitly with article;politicians know the value of nothing.In the last 15yrs successive governements have displayed complete ignorance of the fact that theNHS floats on a sea of goodwill.It is lost-the very people who do 90% of the work a re fatally demoralised;the population is aging ,complex and needy.I have just spent an hour to ear n some money by reviewing patients attending a+e -we could not have prevented any -they were all old visited in their homes -supported by community matrons but still warranted and neede d hospital admission.Can,t wait to retire-would advise any sane human never to choose general practice as a career.All my partners feel the same!

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  • To be honest I won't burn out at current work load although I do think I've lost my humor among all the paper work somewhere. In other parts of the world, 50+ hours of work is the norm. We in Europe is quite lazy by the world's standard I'm afraid.

    What I don't like is us having to work 50+ hours and be told by someone who works 37.5hours we are lazy, incompetent and overpaid. For that reason, I'd consider leaving.

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  • Just heard Cameron saying that Labour let the GPs get out of out of hours , am I wrong in remembering we were told that if we didn't sign they would impose something worse, I didn't sign up, and despite those who did we still have something worse.
    I did the survey which confirmed what my family would have told me, years ago, working in the NHS as a GP is damaging and destructive and possibly the only thing I would not let my children do.
    Cameron is now talking about culling Badgers in a similar tone to his previous comments on GPs.
    We should all be taking to the streets, not about our terms and conditions but about the systematic destruction of the health service and the offloading of the responsibility of the government to maintain it.
    But I think we are all a bit worn out and scared of being culled, how could we not be ?

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  • Siraj Shah

    With growing fragmentation of clinical care, , politically driven health policies enforced on GP’s and overwhelming bureaucracy a time will soon come when GP’s will be no longer be able to provide safe care to their patients. As a GP for 30 years I was able to spend 90% of my time focused on patient care now I have to spend almost 50% of my time ticking boxes, filling forms, following up patients seen in the secondary care- effectively doing the job of an SHO, keeping track of every penny I may claim for verification purposes! The only beneficiaries of these politically motivated NHS reforms based on focus groups rather professions view are the financially driven private providers set to make huge profits by cherry picking NHS work.

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