As soon as we launched our Battling Burnout campaign at Pulse Live last month, it became apparent we had hit a nerve. GPs queued up to take our burnout assessment in person; at the time of going to press, almost 2,000 have now done so online.
The findings of the survey, outlined in our cover story this month, are alarming, with some 43% of respondents reporting a triple whammy of emotional exhaustion, depersonalisation and a low level of personal accomplishment. But it is the comments that make the most harrowing reading: hundreds of individual stories that together paint a depressing picture of ever-increasing workload and stress.
Pulse’s campaign aims to raise awareness of the challenges of a career that has always been uniquely demanding, and lobby for much more consistent monitoring of GP workload and support – taxpayer-funded and nationwide – for those who need it. But the current high levels of burnout are not simply an occupational health issue; they point to a wider problem with the burden on GPs.
In her opinion piece this month RCGP chair Professor Clare Gerada, who as head of the Practitioner Health Programme is well qualified to speak on the subject, argues convincingly that current levels of exhaustion are the result of the sustained pressure year on year on GPs’ workload, pay and morale. In other words, burnout is not just personal: it’s political.
Which brings us to the other big development this month: health secretary Jeremy Hunt’s demand that GPs resume responsibility for out-of-hours care. Despite weeks of unfairly blaming GPs for the pressure on A&E, furious Daily Mail front pages and dark hints about the future of the GP contract, we still don’t know what this will mean in practice. It won’t mean GPs having to personally provide out-of-hours care, we are assured – but it probably will mean more than GPs simply taking responsibility through CCGs. The best guess is that some form of ‘sign-off’ responsibility will be written into the GP contract, but this has yet to be clarified.
What is certain is just how deep GPs’ opposition to taking back responsibility runs. It’s not just the memory of 3am home visits, or the sneaking suspicion that once GPs are contractually responsible they will be roped into shifts as providers of last resort. It’s not just the likelihood of additional administrative work, or the probability that that work will be inadequately resourced, or that the blame-mongers in Westminster and Fleet Street will be given one more stick with which to beat general practice. Above all it’s the fear GPs will be held accountable for yet one more thing – and one more thing over which they have little control.
For many GPs it is this crushing burden of responsibility that is ultimately the greatest source of stress – the intense pressure of making a snap clinical judgment every 10 minutes, the worry of fighting patients’ corner as they navigate the NHS, the nagging fear that that tricky decision they made last week could result in an unwarranted complaint or GMC investigation.
Despite Mr Hunt’s claims to the contrary, GPs are already painfully aware ‘the buck stops with them’. Over the past decade, they have soaked up more and more responsibility, not least through the NHS reforms. But there is a limit to how much they can take. Our findings on burnout suggest that limit has now been reached.