GPs are facing ‘moral distress’ as a result of not being able to deliver the care they feel they should – including due to remote consultations – a BMA report has revealed.
A BMA survey of more than 1,900 UK doctors – 22% of whom were GPs – conducted from March to April 2021 found that 75% of GPs had experienced ‘moral distress’ at work.
It comes amid an ongoing dispute between the BMA and NHS England over face-to-face appointments in GP practices – and increasing abuse towards GPs and their staff from patients.
The report found that:
- 51% of GPs reported ‘lack of time to give sufficient emotional support to patients’ as one of the top five causes of moral distress, defined as psychological unease when a professional cannot act in what they deem the ethically correct way due to constraints outside their control, such as insufficient staff, resources or time.;
- 48% chose ‘insufficient staff to suitably treat all patients’ as one of the top five causes of moral distress;
- More than four in ten (44%) GPs also reported that ‘moral injury’ resonated with their experience at work – defined as longer-term psychological harm from sustained moral distress, which can lead to severe mental health issues such as depression or post traumatic stress disorder (PTSD).
It stressed that moral distress is not limited to those working on Covid wards, and that GPs too have faced it due to not being able to see their patients face-to-face or having to manage those stuck in the pandemic backlog.
The report said: ‘It is important to recognise that Covid-19 has not just caused moral distress in those directly dealing with Covid-19 patients.
‘Those who have not been able to see their patients directly, limited for example to telephone consultations, or the de-prioritisation of certain patients could lead to moral distress in those not directly dealing with Covid-19 patients, such as GPs’.
But GPs were also most likely to report having experienced moral distress prior to the pandemic, with 67% reporting this compared with 57% of both consultants and junior doctors, the report said.
One anonymous GP respondent told the BMA: ‘I’m very aware that under normal circumstances I could’ve done a lot better, I’m frustrated that the personalised care that I value so much has been wiped out in a sea of demand and different ways of working and I just want all this to end and go back to normal, but I do not see that coming, at least not in the working life that I have left.
‘In January this year I had a particular low point and just wanted to leave to escape the unpleasantness, sheer exhaustion and the long winter.’
Meanwhile, the report also revealed the impact of the challenges GPs have faced on their future plans.
When asked how they have changed their plans for the next year:
- 56% of GPs said they were ‘more likely to take early retirement’
- 32% said they were ‘more likely to leave the NHS/HSCNI for another career’
- 33% were ‘more likely to take a career break‘
- And 25% were ‘more likely to work as a locum’
BMA GP Committee chair Dr Richard Vautrey told Pulse: ‘This research is very alarming but also very important as it shines a light on the extent of the struggles that GPs and doctors across the NHS are experiencing due to the constraints of not being able to provide the care they would like.
‘GPs by their very nature have got into this profession to care and help patients which is what they spent years of training to do. Clearly the serious staffing shortages, years of underinvestment and the demands of the pandemic have taken their toll on GPs and their ability to provide the care they would like to.’
The Government must ‘take this research seriously’ and action the report’s recommendations so that GPs are ‘better protected and can get on with what they want to do most – care for their patients’, Dr Vautrey added.
The BMA has developed a set of recommendations stemming from the report’s findings, including structural solutions such as increased investment and staffing and personal steps that doctors can take such as developing peer support groups, seeking advice and developing a ‘self-care plan’.
Pulse revealed yesterday that the BMA is still waiting for a response that will ‘restore confidence’ in NHS England following the fallout around GP face-to-face appointments.
GPs are facing increasing pressure from patients demanding services return to ‘normal’, with some last week telling Pulse that their practices have received abuse from patients as a direct result of NHS England’s face-to-face order.
And last week, MPs warned that the NHS burnout ‘emergency’ requires a workforce planning overhaul to tackle the huge GP shortfall.
READERS' COMMENTS [10]
Please note, only GPs are permitted to add comments to articles
MORAL DISTRESS——–the poor darlings——–you have to have a heart of stone not to laugh
qw
John Munro
You may scoff, but feeling moral injury makes it more likely that those GPs will leave, and they will be the good ones. They will be the doctors who cannot face carrying on when they know they cannot do a good job with the time and resources available. Those that are left will have an even worse time with increasing workload. It will be a vicious downward spiral. Patients will suffer too.
We cannot keep blaming the GPs for not having the resources to do a good job. They are far from lazy. There are just not enough of them.
I think the morale distress is related to treating unlimited access. For free. At the quality and expectation of a private clinic. Same day. And complaints and Government buggery permissible.
I don’t think that you can blame the patients as they are only doing what they have been advised to do by the system and the system cannot cope
Experienced GP’s at the end of their careers wiil have had enough and will walk when they think that their practices are on some sort of even keel.
What then?
John Graham Munro. You mock GPs who are upset by not being able to do their work properly and in particular give proper ‘care’ for their their patients. That says one hell of a lot about you as a doctor and I thank God that I am not one of your patients.
the government is not interested in YOUR distress. they will carry on working you to the bone, and dumping on you, until YOU (i.e. all of us) do something about it. because the gp contract is open-ended they can do this.
the only realistic way of doing this is either to decline stuff that you are not contracted to do – i.e. “ganfyd” letters, insurance work, firearm, passport, and stuff like dvla work, or to reduce the hours you work.
in locumland, i start at 9am, and go through to the end of contracted hours, often without a break. at the end of the day i go home.
if everyone, with one accord, said to the DofH that this was going to happen, and stuck to it, these problems would quickly resolve. the bma should point out to jo public that we are NOT here to chase up the appointment you haven’t received, do a (free) “covid passport” so that you can go on holiday, phone someone’s daughter because she won’t answer the phone to her father who is worried about her (yes – that did happen !), arrange tests for the private infertility consultant, do a duplicate certificate because “the dog ate it”, sign a form (free) to say you are fit (i.e. stupid) enough to jump out an aeroplane for charity, etc etc etc
in prestatyn a few years ago, all 10 gp’s handed back their contract on the same day. the welsh nhs quickly realised there was a problem, and became a bit more reasonable.
perhaps one doctor in the practice could be taken off clinical duties for a day to deal with all this tripe ? patients would obviously have to be told why there are less clinicians around a a particular day, and why they would have to wait longer !
perhaps the bma/DofH/some politician could devise a letter/handout explaining “this is NOT nhs work, and must be done in NON NHS time. it will therefore a) have to wait, and b) be paid for”.
until this happens, i’m sorry to say nothing will change, and we will continue to have “moral distress”.
David Jenkins———methu cytuno mwy
Moral distress or morale distress?? Difficult to tell as I can only feel the more remote you become the worse both will eventually become. Time to “Take back control” and re-order GPs into their actual role of being a General Practitioner once more.
David Riley———-If G.Ps. are going to make themselves ill by not being able to look after their patients properly, they are then of no use to any one.——- I suggest you go back over my past comments and you will see that I emphasise doctors should stop playing the martyr by joining the ever increasing ”victimhood” ——-That said — I still maintain that the majority of practitioners are lazy and Covid has exposed them