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‘We are being regulated to death’



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