For much of the last year, Pulse has been campaigning to raise awareness about rising levels of stress and exhaustion among GPs. Our Battling Burnout campaign has shone a light on a subject which even GPs often find it hard to talk about.
As well as seeking to publicise the problem, we made two very simple demands: that there be better monitoring of GP workload, and that GPs who need it be offered much more consistent occupational health support, nationwide and taxpayer-funded.
So the news today that NHS England has ruled out universal funding of occupational health services, and that the review it has conducted over the past few months will propose providing support only where performance concerns have already been raised, comes as a real blow. True, GPs in England will no longer be subject to the postcode lottery of support the review identified – but the amount of support on offer will be levelled down, not up.
It seems the story we reported last month from Cleveland, where an NHS England local area team had pulled funding from all occupational health support not directly linked to a formal performance review, was sadly prescient.
At the time, local GPC representative Dr Bill Beeby pointed out that pre-emptive support was designed to prevent GPs from ‘going over the edge’, and warned: ‘The problem is, when it becomes a performance issue… it’s already too late’. Unfortunately, that argument appears to have made little headway with the powers that be at Quarry House.
There are two reasons why NHS England’s decision today is a misguided one.
First, in purely practical terms, it is short-sighted. Pulse’s campaign has established beyond all doubt that burnout is a pressing problem for a profession already in the grip of a recruitment crisis.
Our asssessment of almost 1,800 GPs using the validated Maslach Burnout Inventory tool back in June found that as many as 43% of GPs were at very high risk of developing burnout. A separate, multi-topic survey found one in 11 GPs has taken time off work due to stress or burnout within the past 12 months. The Practitioner Health Programme, the largest service in Europe for doctors with health concerns, has seen the number of new doctors and dentists seeking help more than triple in the past four years. Even ministers acknowledge that stress is forcing GPs out of the profession.
Burnout, then, is a very real problem, and one that is costing the NHS in strictly financial terms. We have yet to see any impact assessment that NHS England conducted as it made its decision, but given the cost of training a GP – and the current shortage of them – it seems hard to believe that pre-emptive occupational health support isn’t a cost-effective investment.
But even regardless of the cost-benefit argument, many GPs will feel that today’s decision is simply the wrong thing to do, and sends a bleak message to hard-working doctors who in many cases have literally given the best years of their lives to an apparently ungrateful NHS. We talk of a ‘military covenant’, acknowledging that the nation has a duty of care to its soldiers and servicemen, a duty of care which includes paying towards healthcare costs for physical or mental injuries. Working as a GP is obviously very different from serving in Afghanistan, but there is an argument that a similar principle should apply – that we should have a ‘medical covenant’, if you like, whereby the NHS should take care of its own.
Although NHS England’s review has recommended against routinely funding occupational health services, we are told that the recommendation is a ‘proposal’, with a final, formal decision yet to follow. Managers there should take a long hard look at the decision – both its practical implications and the message that it sends to dedicated doctors working for the NHS – and they should reconsider. If not, it will appear all the concern, alarm and anger over the growing problem of GP burnout has fallen on deaf ears.