GPs have told the BMA that stress and burnout is causing doctors to leave the profession or work abroad, and whilst stress can affect everyone, the impact of doctor burnout can be so much more severe as it can have a considerable impact on patient care. This perhaps makes it all the more worrying that, whilst a third of GPs already lack access to occupational health, the Government is putting the service in jeopardy by axing funding for all cases of burnout, apart from those where stress has already raised performance issues.
The BMA believes that specialist-led occupational health services should be provided for all NHS staff – staff who work in difficult conditions and are facing a large number of mounting pressures including rising workloads and work intensity. Guidance from the Department of Health and the NHS already supports the provision of these services for NHS staff, so why are the Government now putting them at risk?
‘Central hub’ won’t work
NHS England’s Head of Primary Care Commissioning, David Geddes, has suggested a central hub for occupational healthcare, where GPs can access services locally, but receive complex support in one of three proposed hubs across England.
However, I consider this wholly wrong for a number of reasons – primarily because asking someone who is acutely unwell to travel a reasonably long distance is both insensitive and inappropriate.
Although NHS England argues that this will save money, the reality is that it will create less comprehensive local services, which could in turn prevent GPs from seeking help. In the long term this could lead to them requiring more expensive crisis treatments and would mean they would have to stop working.
With workload already causing significant pressure and concerns mounting about the prospect of early retirement amongst GPs, this proposal is likely to lead to greater expense to the NHS over the medium to long term.
NHS England is also excluding practice staff from accessing the newly constituted services and is expecting GPs to cover the cost of occupational health service for their staff from current practice funds at a time when budgets are under huge stress and funding is not increasing.
Each year, the BMA surveys a group of doctors who qualified in 2006 to assess trends across the NHS. Nearly half of those doctors told us last September said that their stress levels were worse or much worse than they were the year before, and a third of newly-qualified GPs said that they had experienced high or very high levels of work-related stress.
This combined with a wealth of research suggesting that doctors have high rates of mental health problems including depression, anxiety, and emotional exhaustion, emphasises the growing need for specialist-led occupational health services.
Evidence suggests that consultant-led occupational health support can improve staff engagement and perhaps most importantly, positively impact on patient care.
In Devon and Cornwall the number of GPs accessing occupational health services had risen from one in 83 in 2000 to one in 17 in 2012 – a rise of 400%. Some 80% of those who had access to such services were able to return to work but yet there was no guaranteed funding for this vital resource.
If GPs are unable to get the help they need face the prospect of their condition worsening and becoming a risk to patients, and their career, before they get access to help from OH services.
As someone who suffered from depression during my medical house job, I know how difficult it is to admit to yourself that you need help. Being able to phone the local occupational health department made it easier to make that first contact and ensured immediate care was arranged.
The last thing you should do for burnt-out health professionals, responsible for the safe and effective care of patients, is to put barriers in the way of providing access to help when they need it.
GP practices are already struggling with declining funding and rising patient demand, which is impacting on both their physical and mental health. In order to support and encourage them, the Government must recognise the increasing pressure they’re facing along with the difficult conditions they are working in, and accept that specialist-led occupational health services are essential to the health and wellbeing of both NHS workers and their patients.
Paul Nicholson is the chair of the BMA’s occupational medicine committee.
