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Revealed: The rising tide of GP burnout as NHS cuts support

Exclusive Rising numbers of GPs are so stressed during their working day that they are at a high risk of burning out completely, reveals the largest ever survey conducted in the profession.

The Pulse survey of 2,230 UK GPs shows 50% are at high risk of burnout, up four percentage points from the same survey two years ago.

GP leaders say the health service has become an ‘industrial hazard’ and that burnout is forcing more GPs to leave the profession.

But the few occupational health schemes providing support to struggling GPs in England have had their funding cut and in Scotland NHS managers are looking at charging for their services.

The Pulse survey shows that three-quarters of GPs feel emotionally exhausted while 25% report a low sense of personal accomplishment.

Dr Daniel Mounce, a former GP in Bradford, left the profession ‘after falling apart mid-consultation’.

He said: ‘For me, leaving general practice has been like leaving an abusive relationship. The shaming and invective, the fear, the unreasonable demands were about driving down self-esteem. I can’t quite believe I ever thought I could stick it for another 30 years.’

Doncaster GP Dr Shahzad Arif, who was recently slapped with a breach notice by NHS managers after burnout forced him take sick leave, told Pulse he was ‘frustrated’ at the total absence of support.

He said: ‘I think it was perhaps something waiting to happen; there was a slight trigger that day because the practice had been unusually busy and I decided I need a break, I couldn’t go on.’

June 2015 issue cover story - GP burnout infographic 460x368

In response to the first burnout survey, Pulse launched its Battling Burnout campaign that last year won a pledge to fund occupational health support for all GPs in England.

But NHS England has yet to release the long-overdue service specifications, and in the meantime has slashed funding for previously excellent mental health support services in Devon, leaving GPs to resort to self-funding.

In Lancashire and Cumbria, LMC chief executive Peter Higgins said that NHS England scrapped the previously ‘very good’ services in 2013, and it has so far refused bids from the LMC to have mental health service put in place.

In Kent, LMC medical secretary Dr John Allingham said: ‘We are hanging on by the skin of our teeth. We have occupational health funding for next year, but nothing guaranteed going forwards.’

It is the same case in Lothian, where GPC executive member Dr Dean Marshall tells Pulse there was a counselling service and occupational health ‘but now they’re talking about charging GPs for it’.

Former RCGP chair Professor Clare Gerada, medical director of a confidential mental health service for doctors in London – said: ‘The NHS at the moment is an industrial hazard, and especially for GPs. Of course we go beyond the call of duty, but to do so every single day is causing great harm to GPs.’

Professor Gerada said her service - the Practitioner Health Programme - had been forced to shut its doors for six weeks in March after a ‘massive increase’ in demand, most of it from GPs.

It comes as the Government plans to roll out seven-day working for GP practices and NHS England’s Five Year Forward view plans for GPs to take on more care outside hospitals. The health secretary promised GPs a ‘new deal’ that will be announced this month to ‘look at why GPs have so much burnout’.

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Readers' comments (102)

  • I am not surprised by this report. I reduced my sessions after 24h retirement at age 58 and quit my practice earlier than I had originally planned. More of my colleagues are following at younger ages. The London Practitioner Health Programme is struggling to cope and the London Coaching & Mentoring Service will no longer provide coaching to any post-CCT doctor. No-one cares about GPs or other post-CCT specialists now. Outrageous!

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  • Work 6 sessions a week (3 days a week)
    Rest for 4 days every week
    Still feel burnt out

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  • We must give the same consideration to NHSE.....do nothing out of good will, do nothing that is not funded, attend no meetings and offer no help when they are in trouble. It works both ways and good will is dead.

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  • It is my genuine belief that anyone who continues to work as a GP is already going beyond the call of duty.

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  • Stress level is now unbearable.

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  • It's such a relief not to feel anything . - Dr Zachariah Ombie.

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  • Considering that most GPs these days are part time it's hard to see how they can be feeling burnt out.I would say that they're spoilt.They should compare their situation with those of their patients to see how lucky they are to still have the luxury to retire early due to the very generous NHS pension scheme that scrictly speaking,as being self employed,they should not be entitled to.

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  • As well as banning CQC visits, NICE edicts that don't take into consideration worload implications, and Revalidation I would like to add the "concerned daughter".

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  • "they should not be entitled to."

    Dear Chum,

    "they" should be entitled to it, because it's in the contract "they" signed. I think you would understand burnout and the pressures of modern GP a little bit better if you were medically qualified, but clearly you are not. Many "part time" GPs still work longer hours than the rest of the population.

    Anyway, it matters not, since I'm sure you'll be the first to complain when there is no-one to look after you.

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  • GPs work incredibly hard and IMO should and can only do a maximum of 6 clinical sessions per week. Most hospital doctors are not as exposed to front line patient care - and get PAs for admin, study, leadership and so on. The sooner GPs accept we can't do it all - we can't be both the saviour and the scapegoat, the better. I am working hard in front and behind the scenes to change things. But we GPs need to change as well. We can't fix the system by working harder. We need structural changes.

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  • we have been running a service for 20 years in Devon and Cornwall and have supported over 1200GPs in this time.It was summarily axed with no provision for future on1/4/15 at a time of maximum risk for GPs.Is this just cockup or conspiracy for someones gain

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  • This is another good reason why Physician Associates are so indispensable - they can take over some clinical work and also some administrative burden off General Practitioners.

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  • was burned out at age of 32 even locumming lots hours 6 months as partner finished me off ( I madly thought this would be less stressful incharge of my own practice, the boss etc.. ha).
    2 years in Canada helped me recover with easy walk in and no stress with appointment times and admin. Locum work in UK now seems manageable (other than when I agree to a long term cover and get all the admin as well) and I work between both countries and enjoy the change.
    Remove the beurocracy dont see more that 35 patients per day and Gp land can be good but currently this is not the job so many Gps cant manage and either vote withtheir feet or live in misery which is no good for them or their patients
    This is society as a whole these days in UK anyway we are not a society but a Business like the US. Everyone is working too hard 40+ hours at the intensity of work these days is too much. The intensity of all jobs was lower 10 20 years ago. Its all about the bottom line effieicency and to hell with what it takes from the workers and this is many jobs not just GP

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  • PS 50 -60 hours per week is notrmal for me in UK 35 in canada ie full time (double the cash)

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  • 'Most hospital doctors are not as exposed to front line patient care - and get PAs for admin, study, leadership and so on' #what tosh

    How can Clare justify such sweeping statements about hospital doctors, she clearly has no concept of the similar working stresses that we are under?

    GPs struggle to do six sessions per week - fine, so why does she think hospital doctors won't strugle when most Trusts are now asking for 8.5 and some 9 sessions per week, while still demanding a full committment to revalidation, training, audit, seven day service, service development (I could go on but it's too depressing).

    I know for certain that there is not a single local GP who works more than four days a week in their practice, compared to a norm of five or even six days in hospital. This is not to belittle the stresses you are under, but simply to ask you to acknowledge that it's not unique to you.

    Burnout is everywhere in the medical profession. You should respect that everyone is under pressure, and not persist in building up professional divisions. I'm disappointed in you...

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  • We need to get away from saying some GPs are part time if they work less than 8 or 9 sessions. it doenst make sense when full time is 37.5 hours per week to say that someone who works 6 or 7 sessions is part time when they may be working well over 40 or 50 hours per week

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  • Yes I agree with the hospital doctors comments all doctors are under stress and woring hard dealing with all the revalidation micormanagement demanding patients and so on. The only stres we can say is unique to GP is the running of a smal business which may even fail/lead to bankruptsy. The actual medicine/prefessional bit I'm sure is as stressful for hospital docs as GPs and Ims sure there are stresses that they have that we do not such as hospital managers i imagine.

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  • I wonder what the Intensive Care Consultants would be thinking after reading some of our GP leaders comments of ''Most hospital doctors are not as exposed to front line patient care - and get PAs for admin, study, leadership, blah blah blah ......''.

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  • Whatever we do in the next 5 years we MUST NOT fight each other. Everyone in primary and secondary care is working very hard to prop up a system that is struggling to meet our patients needs.

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  • Pay the GP (partners) more and the stress levels will come tumbling down.

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  • So glad I'm out of it - nearly cost me everything health,family and my life . I feel so sorry for my colleagues still in it - you can only see it once you are outside the self perpetuating circle of abuse. My advice to other GPs is there are always choices in life .

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  • Anon@11.03 Clare referred to six clinical sessions - not just six sessions. Are you saying that hospital specialists don't get PAs for admin, paid study leave, etc? That's not the impression my sister (hospital specialist) gives. I currently work 9 clinical sessions and cope with the admin overflow in evenings and weekends.

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  • Done that "burn out" thing with "knobs on" but 2 years of therapy, change in work emphasis, avoiding uber-competetive attitude in triathlons, and regular time out with family, garden and railway restoration has restored my "calmness"

    Even considered/offered retirement on medical grounds but back "for another swing" (a good ACDC song) but wont take much to change my mind.

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  • Anon@11.32 : Intensive care consultants are not "most hospital doctors" and presumably have their own forums to discuss their pressures. Also they do get PAs for admin, study leave, etc, don't they? That doesn't imply they do not work hard and are not under pressure - just that they have more protection in that respect than GPs.

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  • Witnessed what happened the day after a GP suicide: patients banging on the desk, "Who will be my doctor now? ". My GP partner's death saved my life because I saw what it did to their family - but there were times when suicide seemed the only option and still now I feel I am a failure because general practice broke me. However, I am still here to watch my kids grow up. I was too ashamed to see my own GP as I was terrified of being referred to the GMC. There is no PHP in my area.

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  • Anon 11:52 yes, that exactly what I mean. New consutlants are now routinely appointed on a split of 8.5 DCC to 1.5 SPA, which is 8.5 face-to-face clinical sessions per week. Far too many consutlant have contracts in excess of 10 DCCs. We swap the stresses of running a small business for the pressures of having to respond to every whim of the managers, CCGs and NHS England

    I am supportive of your workload issues, but hugely disappointed at the ignorance displayed about ours, especially from your 'leaders'

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  • Doctors need to rediscover their professional status. We seem to define ourselves by our employment. We are a profession that essentially contracts to work for the NHS. If that feels like submission then we need to redefine and readjust our relationship. Alter your mindsets - Doctors are not the NHS. We are doctors.first and foremost. and increasingly doctors who understand this will avoid this unhappy unbalanced relationship by emigration.

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  • An all Salaried-Model (and definitely NOT and All-Partnership model) could also be a remedy to reduce the stress for some of our GPs - because the Salaried slaves can do all the work.

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  • At the end of the day we make choices. Theres a new contract and if you dont like the terms dont sign it and do something else. Get your professionalism back be independant and negotiate yyour own terms as private locum overseas doc or in industry etc etc. opportunities abound, 150k per year is easily achievable outside of partnership

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  • GP work has changed a lot over the last 20 years. I can no longer manage my workload and life is miserable. My friends in hospital medicine are under similar pressures and it is generally unhelpful to try and contest who has the worst of it.
    If conditions continue to deteriorate over the next 12 months then I will look to move abroad as I can not keep this going until retirement age.

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  • Vinci Ho

    Fallacy- Efficiency saving
    Collateral damage- Burnout syndrome of all medical professionals
    Apocalypse - Desolation caused by irresponsible politicians and bureaucrats

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  • Global shortage in healthcare workers.

    We are losing our GPs to other countries who can offer better terms and conditions as they offer a mix of private and state. We must do the same to hang on to our brightest and best and attract the best.

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  • Didn't think I could ever have done another 15 years at 4 days a week without breaking down. However now I work 4.5 to 5 days. Don't feel exhausted, every day feels like a holiday and I can easily see myself working another 20+ years! I have also increased my income. How? I'm in Australia of course. If you can, move over here quickly before they raise the drawbridge!

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  • Gritting teeth and hanging on for 18 months
    ........would prev had considered going to 65
    ........now not sure I will make 59

    .......Huge sympathy for those following behind and those in hospital

    ......If paid more ......I would reduce my hours immediately so that I could reduce the workload and maintain my sanity...and probably be able to go on longer.
    ......but where would I find anyone to take up the slack?

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  • I am not saying hospital doctors are not struggling. Of course they are. But GPs are the only group singled out as being 'lazy', we have this added burden. And 'how can I say what I say'? because I look after 100's of sick health professionals - I get all their stories. I find out what other hospital and other doctors do, what their week is like and how bad in comparison it is for GPs.

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  • And yes, I am talking about CLINICAL sessions.

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  • Clare is right - all doctors or even all clinicians are under pressure but the press has singled out GPs as being lazy. There was a lot of sympathy for front line a&e staff in the press (rightly so) but never for GPs. However, more sympathy isn't going to help. I see a total collapse in goodwill and GP who are still partners all seem unhappy. I don't know a single GP partner who isn't stressed. We really need to look at our option as a profession and start debating the contract vs salaried vs alternative models. if not there won't be anyone in the profession left !

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  • 2:28pm ''I don't know a single GP partner who isn't stressed''

    You must be joking

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  • If we don't like the contract, do something else? Hardly a fair suggestion when it is outside influences wrecking the job. I have spent many years building up my practice serving a population most of which would not afford private health care while NHS payments are still being deducted from taxes. Yes, I could retire early, emigrate, try locuming or apply to work somewhere else on a salaried basis but why should I? Am I not allowed to protest at the damage being done to general practice in the hope it will stop? I didn't vote for the 2004 contract. I had no say in the current contract. Pre 2004 I didn't much care about the contract as it was not such an intrusive part of my working life. Since then, it seems to have been used to catch us out, beat us over the head and generally interfere with the business of actually looking after patients. It shouldn't be like this.

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  • Anonymous | GP Partner | 04 June 2015 10:11am

    Considering that most GPs these days are part time it's hard to see how they can be feeling burnt out.I would say that they're spoilt.They should compare their situation with those of their patients to see how lucky they are to still have the luxury to retire early due to the very generous NHS pension scheme that scrictly speaking,as being self employed,they should not be entitled to.

    This is the most outrageous comment I read in this article. So apparently this GP Partner thinks we should be treated like the average working class, blue-collar patient, who for whatever reason, did not manage to get the grades to do medical schoool, who did not slave away in foundation training or GP training. Wake up pls, we are highly trained professionals and whatever others might say, are worth our weight in GOLD! if not more. or at least, surely more than NHS managers, lawyers, CQC/GMC etc.
    But no, I bet this person thinks I should be paid the same as my receptionist, that I don't deserve to have support for work-related stress, or a pension, or to enjoy the fruits of my labour.
    I do sympathize with my (less advantaged)patients all the time, but also recognise that WE GPs worked hard to get where we are, and if the UK does not recognise our (current batch of GPs) value, we will go somewhere else where we're appreciated

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  • I love this job as a GP and can hardly wait until I can do it 7 days a week . Sorry this is written in crayon but they don't allow sharp objects in here...

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  • Can Statins prevent GP burnout.

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  • The Government has some weird notion it can run an NHS without happy doctors. In 10 years time doctors will tell their children to go into property or law.
    How sad.

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  • "In 10 years time doctors will tell their children to go into property or law. "

    People are steering their children away from medicine already. Why would you send a loved one into a warzone?

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  • My sons have seen the effect that my work has had on me over the past ten years. They would not rich medicine with a barge pole.

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  • Touch, obviously. Jeez, I'm supposed to be a writer.

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  • I still think Clare is right - we should have an inclusive democratic debate with ALL GPs about our future - we can discuss potential solutions and potential actions to take if we don't get a desirable outcome. We just can't keep talking and complaining about how bad things are we need action !

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  • Thanks 3.43
    I want a debate. When ever we start one it becomes personal and attacking and splitting. We have few friends out there - and hence we should be strong together and find ways out of this.

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  • A mix of public and private like the other countries that are attarcting our doctors.

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  • Action needs to come from our supposed betters,BMA,RCGP where are you in our hours of need.The governement need to be held to account (all the last few governenments red and blue and yellow)they have to be confronted(as any bully).If they are not we are lost and th NHS with us.

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