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Internal NHS England review reveals stark variation in occupational health support for burnt-out GPs



Exclusive GPs across almost a third of England have no access at all to occupational health services, while the support available elsewhere varies starkly, according to the results of NHS England’s own fact-finding exercise.

The information collected as part of NHS England’s internal review, obtained by Pulse under the Freedom of Information Act, shows a huge variation in provision, with 32% of the 78 legacy PCT areas which were able to provide information having no contracts in place to provide occupational health to GPs or their staff.

Even where services are in place, there is a marked variation in the level of support provided and the funding attached. The 35 areas able to provide figures spent an average of 11p for each patient registered with a GP in the area, with Cornwall spending as much as 31p per patient but Sefton in Merseyside spending just 1p per patient.

The exercise, which was completed in July, saw NHS England investigate the current level of provision to inform an ongoing review into whether occupational health services should be funded across the country. NHS England is currently finalising a nationwide plan to provide all practices with ‘a consistent offer of occupational health services’ for GPs and possibly practice staff, and expects to publish full details by the end of October.

A Pulse survey of 441 GPs last month found one in eight respondents had sought help from pastoral or wellbeing services within the past year, with one GP spending almost £2,000 on private psychotherapy after finding it difficult to handle his workload.

A separate Pulse assessment earlier in the year of almost 1,800 GPs using the validated Maslach Burnout Inventory tool found that 43% are classified as being at a very high risk of developing burnout, with partners and those working in deprived areas particularly badly hit. Pulse is lobbying for better monitoring of GP workload and consistent occupational health support for GPs – taxpayer-funded and nationwide – as part of its Battling Burnout campaign.

In some areas, the NHS England review found that extensive services are in place. In Brighton, for instance, GPs who need support are offered phone and website advice or face-to-face consultations with 48 hours, plus up to six sessions of cognitive behavioural therapy.

However, in 25 of the areas to respond to NHS England’s request for information, no services are provided. The devolved governments in Wales and Northern Ireland provide GPs with occupational health services free of charge, while in Scotland it is provided in some areas.

GP leaders said this variation showed that GPs were not being treated fairly in relation to other medical professionals and called on NHS England local area teams to ensure that occupational health services were reinstated for GPs.

Dr Mark Sanford-Wood, acting medical secretary of Devon LMC, said GPs ‘hugely value’ the NHS-funded service in his region, which includes ‘mental health support, plus other services such as cognitive behavioural therapy’.

Escalations in GPs’ problems have been avoided in some cases, Dr Sanford-Wood said. ‘The cost is a drop in the ocean compared to impact on GPs’ health and the knock-on effect on patient services.’

GPC deputy chair Dr Richard Vautrey said: ‘We think that the provision of occupational health services to GPs and practice staff should be on a par with everyone else in the NHS. GPs should be treated fairly, in the same manner as their colleagues in hospital. We are already aware of the high number of GPs suffering from burnout and stress and occupational health services can help provide the appropriate support for that. It is valuable for providing a range of services, including immunisation.’

RCGP chair Professor Clare Gerada said: ‘GPs are struggling to keep their heads above water – and some are drowning. There needs to be an investment. You need healthy GPs to serve the rest of society, but at the moment GPs’ workload is increasing and morale is going down.’