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GPs go forth

GP occupational health services are essential to patients’ health too

Cuts to occupational health services make it harder for GPs to admit they’re burning out, which puts patients at risk, argues Dr Paul Nicholson

GPs have told the BMA that stress and burnout is causing doctors to leave the profession or work abroad, and whilst stress can affect everyone, the impact of doctor burnout can be so much more severe as it can have a considerable impact on patient care. This perhaps makes it all the more worrying that, whilst a third of GPs already lack access to occupational health, the Government is putting the service in jeopardy by axing funding for all cases of burnout, apart from those where stress has already raised performance issues.

The BMA believes that specialist-led occupational health services should be provided for all NHS staff – staff who work in difficult conditions and are facing a large number of mounting pressures including rising workloads and work intensity. Guidance from the Department of Health and the NHS already supports the provision of these services for NHS staff, so why are the Government now putting them at risk?

‘Central hub’ won’t work

NHS England’s Head of Primary Care Commissioning, David Geddes, has suggested a central hub for occupational healthcare, where GPs can access services locally, but receive complex support in one of three proposed hubs across England.

However, I consider this wholly wrong for a number of reasons – primarily because asking someone who is acutely unwell to travel a reasonably long distance is both insensitive and inappropriate.

Although NHS England argues that this will save money, the reality is that it will create less comprehensive local services, which could in turn prevent GPs from seeking help. In the long term this could lead to them requiring more expensive crisis treatments and would mean they would have to stop working.

With workload already causing significant pressure and concerns mounting about the prospect of early retirement amongst GPs, this proposal is likely to lead to greater expense to the NHS over the medium to long term.

NHS England is also excluding practice staff from accessing the newly constituted services and is expecting GPs to cover the cost of occupational health service for their staff from current practice funds at a time when budgets are under huge stress and funding is not increasing.

Each year, the BMA surveys a group of doctors who qualified in 2006 to assess trends across the NHS. Nearly half of those doctors told us last September said that their stress levels were worse or much worse than they were the year before, and a third of newly-qualified GPs said that they had experienced high or very high levels of work-related stress.

This combined with a wealth of research suggesting that doctors have high rates of mental health problems including depression, anxiety, and emotional exhaustion, emphasises the growing need for specialist-led occupational health services.

Evidence suggests that consultant-led occupational health support can improve staff engagement and perhaps most importantly, positively impact on patient care.

In Devon and Cornwall the number of GPs accessing occupational health services had risen from one in 83 in 2000 to one in 17 in 2012 – a rise of 400%. Some 80% of those who had access to such services were able to return to work but yet there was no guaranteed funding for this vital resource.  

If GPs are unable to get the help they need face the prospect of their condition worsening and becoming a risk to patients, and their career, before they get access to help from OH services.

As someone who suffered from depression during my medical house job, I know how difficult it is to admit to yourself that you need help.  Being able to phone the local occupational health department made it easier to make that first contact and ensured immediate care was arranged.  

The last thing you should do for burnt-out health professionals, responsible for the safe and effective care of patients, is to put barriers in the way of providing access to help when they need it.  

GP practices are already struggling with declining funding and rising patient demand, which is impacting on both their physical and mental health. In order to support and encourage them, the Government must recognise the increasing pressure they’re facing along with the difficult conditions they are working in, and accept that specialist-led occupational health services are essential to the health and wellbeing of both NHS workers and their patients.

Paul Nicholson is the chair of the BMA’s occupational medicine committee.

Readers' comments (7)

  • The Faculty of Occupational Medicine supports the campaign to protect access to OH services for GPs. Paul highlights the positive effect that early, confidential OH support can provide, particularly for those working in high-performance jobs.

    Our aim is to provide universal access to OH support, but it is essential, given that patient care is at stake, that GPs do not lose access due to funding issues. To reduce access to services, at a time when GP practices are being asked to do more with no extra funding, seems a short-sighted decision that will ultimately prove more expensive for the NHS in the long run.

    Read the full press release on the Faculty's website -

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  • In some ways, it is trying to bring the horse back after it has bolted. While OH is crucial for ill doctors, prevention is the real crux. Having worked in both primary and secondary care for 35 + years, it is the sheer volume of work, the dangers of running at 100 mph every single day, the constant worry of being right every time under intense time pressure and multitasking that is the cause of this breakdown and burnout. It is for the doctor's Union to address this
    workload issue for both patient and doctor safety.
    I speak, having done over 700, 80 hour [ fri 9am to mon 5pm] weekends in the NHS, many, many of them with 3-4 hours sleep. It illustrates the problem of working in the NHS. There is no duty of care to its workers. Mid- Staffs 2005 happened after mangement cut 150 staff in 2003. Strangely, it is the workers left behind, working twice as hard in extremis, who get the blame and not the management. It is logically absurd. But the cure is simple, have proper staff patient ratios fer each speciality.

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  • Should GPs be euthanased at the end of their useful lives?? That will one day be the article in The Daily Mail. We are all viewed as dispensible machines....there to abuse until the pieces fall apart and then discard. Seems like a story from Hollywood...maybe this is our future.....
    Even Article 8 – Right to respect for private and family life under the Human Rights Act is at risk as we are being threatened to work 7 days per week.
    Demonised and blamed for societies ills by the politicians has a very menacing feel.....this is the slippery slope.
    I fear what the "final solution" will be for GPs........

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  • Don't worry, Paul Dacre (Editor of The Daily Mail) will be more than happy to seal GPs' fate....

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  • so terribly short sighted callous and foolish
    a complete total and utter disgrace

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  • what a lovely caring setup nhs england are..may they be made accountable in the future for such decisions

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  • I was at a recent Conference on Reducing the Stigma of Healthcare use amongst Healthcare Professionals. I raised this OH issue from the floor and was informed that OH services would still be available for GPs (since they are in direct contract to the NHS) and not for their staff (as employees of self-employed contractors).

    I was NOT told that OH help would only be available at three national hubs and not more locally.

    Doctors are not exempt from the principles of self-help any more than those to whom they minister and all of us have a duty of care both to ourselves and others. Such mechanisms as Balint Groups; more non-psychodynamic solution-focused appreciative-inquiry based groups are all possible and CCGs should be placing a far higher priority on setting them up - working across their 'boundaries' to enable them to be. THIS IS AN URGENT NEED as increasing numbers of people are falling over and burning out (see Pulse survey of last year and the 2013 GP Worklife Survey)

    These, along with other vital trainings in self-care/resilience/secular meditation/mindfulness could also be provided easily by both national and local practitioners.

    OH services such as PHP in London (the only one currently) need to be sustainably funded by CCGs - in this case across London will all divvying up at least the £1mn required to ensure a highly-valued, effective and sustained service. 3 hubs will be nowhere near enough for all the reasons discussed and, in the current climate, will almost certainly not be trusted.

    Delivery of PHP (or PHP-like) services at more local level has got far more 'legs' and would also match all the current worthy rhetoric relating to 'community' and 'localism' - neither of which adjectives can be applied to the Behemoth (certainly no moth!) that is NHS England!

    Dr Chris Manning MRCGP

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