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Independents' Day

'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)

  • One of the few things to be said about US healthcare is that the doctors have no false sense of duty. the economics of health is foremost.

    I hated that about it, however seeing where the UK has gone I wonder if the US system however brutal was correct after all.

    I can't even start to imagine the stress these dr's must have under, just unacceptable.

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  • Vinci Ho

    The currently set low threshold to trigger an official accusation in all forms( complaints , legal actions from no win , no fee legal firms, reporting to GMC) has certainly been eroding into the principle of presumed innocent and guilty until proven in Common Law. This has been interpreted as better way of 'protecting the patients' . Question remains ' have they got it right and proved doctors guilty in most of the cases?' I think the evidences presented even by GMC has explained that.
    Are patients better protected? I guess not . In fact , it is worse because whistleblowers are subjected to this cruelty as well. Where is the justice to be set?
    GMC has a lot to answer to the public if a system like itself has the risks of causing substantial cases of miscarriage of justice but let loose the real culprits......

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  • Pamela wibble md did a piece around physician suicide in the US on emedicine. She conducted a psychological autopsy on three deaths. She talks about primary, secondary and tertiary prevention. Well worth a read guys. Please Speak up and seek help. The LMC can be a source and there is a practitioner health programme in London. NHS E also has occupational health services that can be contacted. We have to support each other. We also have to build sustainable systems in practice.

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    This is.a link to the article. It is quite disturbing but powerful.

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  • Nasir --- there is a reason the American Civil War happened and there is a reason the Boston tea party occurred
    It is said that all that glitters is not gold and I am sure it is the Americana who coined the phrase TRUTH JUSTICE AND THE AMERICAN WAY
    God bless the good old USA

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  • Took Early Retirement

    The brutal truth is that whereas the GMC considers patients to be sacrosanct, the lives of doctors are expendable.

    If anyone cares, do as I have done. Report the GMC to the Manchester Police and the Health and Safety Executive. In my view they are guilty of homicide.

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  • Regulators have a particularly poor record in Derbyshire and Nottinghamshire. Doubtless you have read about the dentist locally and the ridiculous recall of 22,000 patients on spurious grounds. You won't be surprised that £millions wasted has shown that there is no evidence of HIV or Hep raised in these patients or that the unfortunate young lady who died from viral myocarditis was not a victim of the dentist. But we all knew that didn't we? What you may not know is the £millions that were wasted giving dentists contracts that were four times the size that they should have been. That these were not monitored correctly and the CQC inspected the practice and pronounced it fine 3 months before the whistleblower
    While on the subject of Regulators. The dentists won the High Court case against the GDC, who were found to have acted unlawfully. Despite this the GDC said it would be 'too difficult' to give the money back (ARF increased 55%) and the judge agreed and said that since 'all dentists' pay higher rate tax' it wouldn't hurt them too much. The costs were awarded against the GDC. Unfortunately the GDC has no money other than from the dentists; so guess who has to pay?
    The dentists experience similar tragedies regarding suicide, but the GDC aren't interested. Its time that the doctors and dentists got together to put the unaccountable regulators and commissioners in the hot seat?

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  • Vinci Ho

    Nial Dickinson needs to realise that the current process of referring to fitness to practice panel of GMC can be abused as a mean of bullying. Clearly, bullying can lead to death .
    Reading the comments( nearly 100 comments) in the main article on the subject , the process of handling a referral case appears to be flawed. Disrespectful, presumed guilty and disdainful are the main themes. Even the Police cannot behave in these ways when they are at the stage of receiving and investigating a crime.Yes,the whistleblowing can be true as well as false allegation .GMC must serve for both fairness and justice. This is no country like China , Russia or North Korea . There is a reason why Themis , the Greek Goddess , is blindfolded for objectivity. Not sure GMC had displayed an understanding of that?

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  • When patients or their relatives can complain about you on line to the GMC it is little surprise that so many of us will recieve a fitness to practice investigation letter .the threshold for an investigation is so low it's again no surprise that a vulnerable person will possibly find it all too much and opt out of life .I like to think of myself as a robust individual , but after 31 years as a GP I got just such a letter of investigation into my fitness to practice this year .The letter came on a Friday when I got in from work at 7pm , and made me feel physically sick and acutely depressed .The complainant was a serial litigator who had complained about just about everyone involved with the case the trust the nurses and even assaulted one of my district nurses.I am lucky to have a great wife and family ,I was depressed by the process and slow pace of it .When it was found that there was no issue with what I had done , I was not even advised that there was no case to answer .However my local performers list wrote to the GMC with detail of historical complaints all of which had been settled at the local level.This triggered a further letter of investigation of my fitness to practice ! I have had fantastic support from my indemnity insurance provider , and it makes you realise why fees are now nearly £12000. A year ! The stress of it all has made me question being a Doctor and I am retiring at 55 next year .What happened to the job I loved ? No wonder there is a recruitment crisis .This overhaul is long overdue .

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  • Our workloads will rise inexorably with an ageing population and increasing illnesses such as dementia and diabetes. As workloads spiral, we are bound to make more mistakes.The prize winning essay by Dr. Sassa in the BMA news review about 80 hour weekends with 3-4 sleep highlights the fact that that is what is expected of us. No one cares about us doctors and our workloads.
    This is our problem - definition of safety. How many patients and hours each day is safe for doctor and patient?
    This has been the BMA's Achilles heel. I have done over 700 80 hour weekends. A+E Consultants still do these. My colleague can see 65 patients in a day when he does GP during the day and OOH at night.
    Average list size means that there is no respite ever, only more work.
    We have to move to a system of payment for work done such as pay per appointment.We have to define safety in numbers and hours.
    It can be done. The EWTD regulation did something for juniors the BMA should have done for ALL doctors.
    The fault of increasing and uncontrolled work falls at the feet of the BMA. our Union. Pilots do not do dangerous hours. Their Union says so.

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