General practice on the couch: 'I have been struggling for a while'
Dr Michael Banna describes how he tried to get a new CBT client to see the positives in their situation
This week I saw a new client. The client was General Practice. General Practice had never seen a therapist before, but to be fair I’d never had a profession as a client, so we were both treading unfamiliar waters. ‘I’ve been struggling for a while,’ they started. General practice seemed fed up, as though they had simply had enough of even trying to put into words what their problems were.
Positivity is unlikely to change the circumstances of the job, but it might just change how you feel
As I do with all my patients, I asked why. 'So much has changed,' General Practice began. 'The workload has gone up, the demand has gone up, and the resources have dwindled if anything. We feel drained, burnt out and unsupported.'
'Why do you think things have changed so much?' I ask, trying to get to the bottom of their sullen look, and why they seemed so jaded about their career.
'I think it has a lot to do with perception vs reality. People look at GPs and they think it’s easy. Tea and biscuits, leisurely chats with a few patients then off to the golf course, all the while pocketing massive incomes. So when we say we are struggling, nobody listens.'
‘But people are starting to listen aren’t they?’ I say, ‘What about the new money announced for General Practice by NHS England in the GP Forward View? It seems there are new resources?’
‘There is one thing that the GP Forward View is definitely not, and that is new money. I’ve been around this block enough times to know that this will be the same money cleverly moved around, spun to sound impressive while changing very little, and there will most certainly be strings attached… Heavy strings,’ says General Practice, slouched on my couch.
‘But at least it’s something’, I say.
The shrug of General Practice’s shoulders at this suggestion was the deflated resignation of someone who had experienced having their hopes dashed many times. They are seeing the negative in everything that is thrown at them.
‘Also,’ General Practice sighed, ‘We find it impossible to recruit new GPs. This makes the workload harder, and with so many of us coming up to retirement I just don’t know what’s going to happen.’
'Does it surprise you that recruitment is so difficult when the picture you paint of your reality is so bleak?'
'I completely understand what you’re saying' - General Practice is a born diplomat - 'but how do we highlight the struggle to the Government and those responsible for changing things while simultaneously shouting from the rooftops about how awesome life is to make people want to join us?'
I don’t have an answer for this, but I’ll hazard a guess that the problem is not that they’re being too positive. 'So if it’s so bad, why do people still do it?' I ask, trying to get them to focus on the good parts of their career.
General Practice considered this carefully. 'Well, many have stopped doing it, and I suppose the ones who are left do it because they still love it - and maybe more importantly, they still care about it, and we take a lot of pride in that care - but that is all being stretched thinner and thinner among fewer people.'
‘But surely if people still love it then there must still be positives in the profession?’ I ask, trying to raise even a whimper of enthusiasm.
‘Well I guess that that the lifestyle is still more balanced than many other medical specialties, and for the most part it is a well paid job, but I suppose that the real positive is in doing the job. It is a genuine privilege to be involved in people’s lives as you are as a GP; that continuity of care of the family doctor. And I suppose that this is the biggest fear- that that part of the job is what is slowly being taken away by all the changes that we are always speculating about.’
‘Exactly,’ I say, ‘It is hard to be positive when you are constantly being told how awful your life is; maybe that cycle has to be broken? There clearly are still huge positives in general practice after all. Do you think you’re just missing them because all you can see are the negatives bearing down on you?’
‘Maybe. It’s just hard to think positively when you feel like you’re being pulled in every direction possible by NHS England, the CQC and patient demand simultaneously. I know my mindset is not helping, but how can I change it? It’s just a reaction to the realities of a career that has become very different to what we signed up for.’
‘Well at least you’re starting to acknowledge the problem,’ I say, ‘Maybe this is one can of worms that needs to be opened. Positivity is unlikely to change the circumstances of the job, but it might just change how you feel.’ I could tell that it was all general practice could do not to visibly roll their eyes and cancel the rest of the sessions.
This may be trickier than I thought.
Dr Michael Banna is a GP in Bognor Regis, West Sussex