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At the heart of general practice since 1960

'We are being regulated to death'

Dr Marcus Bicknell on the GMC’s review into doctors’ suicides

Five Nottingham based GPs have taken their own lives in recent years. I knew four of them well. They were gifted colleagues, but they were also vulnerable. Their primary and secondary mental health needs presented challenges which were beyond the scope of the NHS to resolve. How do we explain these tragic circumstances?

Nottingham sits at the bottom of the league table for recruitment into general practice. While we may wish to attract talented GPs to our locality, the toll on our colleagues hardly makes this an attractive area in which to work. Yet we need new blood to support our struggling and burnt out colleagues.

Unprecedented numbers of senior and respected Nottingham GPs face regulatory pressure from their area team. For some reason, our workforce is either underperforming or being regulated to death. Anxiety is of course increased by the imminent CQC visits. It’s clear the regulators have only a cursory insight into the pressures which they place on clinicians.

We need to start caring for our doctors - not persecuting and punishing them, as this recent GMC review shows. We need to get to grips with the inexorable pressure placed upon us that manifests itself in colleagues resorting to alcohol and self-prescribed diazepam to cope with their mounting responsibilities. We need to know how many of our profession require mental health support. We need to ask: how can we make general practice safer, more nurturing and desirable for aspiring GPs, as well as for the more experienced?

We are trained by dissecting cadavers and have access to lethal medicines on a regular basis. We are different as doctors in our attitude to death and we are trained to be different . Does this have implications for our attitudes towards our own mortality?

So what is suicide from a doctor’s perspective? It could be the ultimate feeling of utter hopelessness? It might always be part of a mental illness, or could be a personal clinical decision to quit? I wonder how the doctor rationalises the finality of suicide as someone who has been taught to care? And how does he or she mitigate against the impact that the ultimate decision will inevitably have upon those who are emotionally and practically close to the deceased?

My thoughts are with our respected colleagues who have lost their personal and professional battles, and with those who loved them and relied upon them. Recently Nottinghamshire LMC dedicated its open meeting to reflection and a discussion as to how we can do better.

These are dark days for doctors. Yet the remorseless tide of change and expectation continues at pace; seven-day working, 111, late night surgeries, multiple service provision and outrageous pension costs are all components of a system which seeks to exploit general practice whenever it can.

We know that our citizens value their doctors over and above any other resource, but do we value our doctors as a society and as a country?

Dr Marcus Bicknell is a GP in Nottingham. He has donated his fee for this piece to The Cameron Fund, which supports GPs and their families in times of financial need, ill-health, disability, death, or loss of employment

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Readers' comments (16)

  • Doctors work too many hours. I did 2 13 hour days back to back. It is exhausting. Even the normal 10-11days are exhausting. Every single day with the ever present threat of mistakes in the 250+ patient contacts each day.
    General Practice is rapidly becoming impossible. No one can run flat out all the time. That is the reason for burnout, GMC complaints, difficulty in recruitment and retention, The average age of female GPs retiring in NI is 40.
    Surely, it is upto the GPC/ BMA to make this profession more do-able. Our negotiators are at fault.
    Someday soon, they have to say enough is enough.
    Really speaking we are enormously powerful, if we just stood up.
    All this altruism and pay cuts, while Management Consultants get paid £3000 to 4000 a day for utter rubbish and MPs get 11% pay rises.
    GPC, if you wish the profession to survive and be healthy, you have to stand up. If you cannot and GP land is dying, then you should all resign, because you lot are devastating this lovely profession.

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  • Regulated to Death is very Sad and pathetic state of affairs in Notts.I will rate this article as %stars for the miserable times and Mirale Primary care .One wonders who cares for our Faternity ?DOHNo No
    Occupational Health No No.Our LeadersLmc Gpc BMa NoNo.Our Peers ?masy be but Who Suffers and cares is our Family and Friends .
    Please please some one Ought to think and act on such a Valuable Lives Losses for them and their family and Friends .

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  • Abdul QADRI

    It is so sad that these 5 Gps had reached to such a low point that they took their own lives. One can't imagine , what kind of turmoil these gps must have been in for months or years before reaching to the dead end. More & more gps are making painful decision of retiring at 55. Future of Gp is bleak to say the least as Seniors are leaving Gp too soon & passing the responsibility to less experienced juniors. Can you blame them ? There was a time when gps could boast to other professions that they can work till 80 & trust me they used to do fantastic job as there was no interference from the so called regulators. So many regulatory bodies or so called think tank have come & gone. They have left horrible legacy behind & ruined the morale of the gps. I have worked as Gp for nearly 32 years & for the best part of 20 years enjoyed the job. Patients would value my advice & wouldn't force me to refer them for unnecessary investigations. This was only possible by trust between the Doctor & the Gp. I am afraid that TRUST has been ERODED seriously by the successive STUPID THINK- TANK. Patients best friend is now GOOGLE & they come with list of expensive demands before Gp & put them under enormous pressure. Besides CQC from the start came with dictatorial attitude & stated criticising everything about Gp. CCG is supposed to represent gps but they have the pressure from CQC , Govt & most importantly private sector who are waiting to take away the services from the gps leaving with less income.
    Frankly it is all mess & no wonder why more people are rushing to A/E causing long waits for really needy patients. Only 15 years ago , I could give timely advice to my patients on telephone & patients had confidence to stick to that advice. Now Gp position has been damaged by CQC after publically labelling the practices as dangerous without thinking about the morale of the gps. Besides biggest bully is the GMC. Even if there is a case against a particular Gp , they need to treat them with respect & equals. After all they are also human & can make mistakes. In my opinion , anybody who receives a complaint from the GMC must & should receive psychological support from day one to prevent this tragic loss of our qualified Colleagues. Finally a simple humble request : DO WE EVER FINDOUT WHAT HAPPENED TO THEIR LOVED ONES ?

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  • I fear this is just another symptom of the governments agenda, divide and conquer creating fear and hate on the way, in order to bring about their pervasive policies without too much complaint.
    As while we are all blaming each other, we take our eyes off the real ball, not me or you or the patients, but the ones writing the policies and legislation. Take care not to fall into their trap, its just what they are manipulating us to do every time.

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  • You may not be aware of a new trend in GMC referrals. Since the removal of majority of legal aid, if a patient who is disgruntled approaches a no win, no fee solicitor to pursue a possible negligence claim (however spurious), the lawyer instructs them straight away to complain to GMC. The GMC then conducts an investigation (at subscribers' expense) and when that is complete the solicitor asks for release of all the details with the patient's consent. This is a fishing expedition for possible mishandling of the case, and avoids the potential litigant or solicitor from spending a penny on their own investigation.
    This is a worrying trend that MPS are aware of and trying to fight, but for now you may as well rip up your complaints protocol and just wait for a letter from GMC. Referrals are increasing exponentially.

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  • We have been investigated recently by NHSE, and the "Professional Adviser" wrote a highly misleading and inaccurate report, which the Performance Steering Group took one look at, and decided to refer us to GMC, without even giving us an opportunity to meet with them to present our evidence. So they acted on a report from ONE person. I have asked my medicolegal adviser to explore whether we should refer the NHSE Professional Adviser to the GMC as well, for withholding vital information and constructing a deeply unfair attack on us. Not had my Christmas card from the GMC yet. We must stand up to this, defend ourselves when we need to, and reflect and learn if we could do better. It's not just GMC you need to worry about. NHSE are even worse! Kangaroo Court QUANGO. GP as we know it is on its last legs. I'm out as soon as this is all over.

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