General practitioners are at the front line of delivering healthcare. More than one million times a day, they have to contain the pain, suffering and despair of their patients. More than many others in the medical profession, they have to face the failures of service provision – be that in healthcare as their patients have to wait longer for operations or cancer treatment, or in social care as many patients find they simply cannot afford the basics to sustain independent living, or failures in housing policy, as lack of affordable housing means increasing numbers of people are forced to ‘sofa-surf’ or sadly sleep in temporary hostels or become street dwellers.
General practitioners are, therefore, working in an environment where no matter how hard they try, they simply cannot make good the failures of funding and decades of lack of investment in provision.
General practitioners are frequently portrayed as both the saviours (as being able to reduce costs by keeping patients out of hospital) and the scapegoats (accused of being profligate with their use of resources) of the NHS, when all they want to do is their job.
Uncertainties about their future, including how to fund their premises; increasing costs of staff; failure to recruit new GPs; demands from CQC; forced practice mergers; and the rising culture of complaints adds to the pressures GPs have to deal with. It is hardly surprising, therefore, that increasing numbers of GPs are becoming depressed and sadly, some of these doctors are taking their own lives. The GP Lucy Henshall recently gave a resounding speech at the LMC Conference in Belfast, where she highlighted the rise in mental illness amongst GPs, and sadly the increasing numbers who are taking their own life.
She and the LMC conference called for action to prevent GPs killing themselves.
GPs are too precious to lose for a systematic failure
Of course, providing timely care for GPs who are depressed, burnt out or having dark thoughts is important – and fortunately the NHS General Practitioner Health Service is now accessible to all GPs in England.
But suicide prevention requires more than dealing with those at the end of their tether and contemplating death. It requires action to improve the working lives and reduce the risk of suicide for all GPs. This needs practical action. Longer time with their patients (at least 15 minutes as routine); fewer patient contacts per week (maximum of 60 patients contacts per week); more time for reflection and supervision such that they can talk, with their peers, about the emotional impact of their work, and, finally, more control of their working lives, not dictated by the latest unachievable target or guideline.
To remain well, collectively, GPs need to be able to focus on what they do best – provide continuity of care, to a registered population, in the context of their patients’ families and communities.
The solutions are complex, and prevention lies in addressing the systemic causes of stress (related to diminishing resources, increased workload and unachievable demands). We call up the RCGP, BMA and LMC to work together to create a new Charter for GPs, one which addresses their needs along side those of their patients.
GPs are too precious to lose for a systematic failure.
Dr Clare Gerada is Medical Director of the Practitioner Health and GP Health Programme
Dr Kailash Chand is a BMA Council Member and retired GP