The ‘problem’ with GPs is that they’re usually the last ones to crack. We continue to work way beyond the point that we should have admitted our problems. Other professions have to worry about absenteeism; we have to worry about presenteeism.
In my experience, GPs literally work down to the wire before they break down. As well as leading the College and being a jobbing GP, I also run Practitioner Health Programme (PHP), the largest service for sick doctors in Europe.
Anecdotal stories of overwork can provoke interesting reactions – patients ask whether GPs live in their surgeries because they work such long days. But other accounts are more concerning, with one GP crying before they even turned on the computer.
The term ‘burnout’ can undermine the severity of stress-induced health problems that GPs face, but whether we’re showing the lesser symptoms of stress or having a breakdown, it’s clear that we prefer treating our patients to looking after ourselves.
A workload crisis
The challenges of failing to recognise or seek treatment for our health have been compacted as part of a 15-year intensification of the GP workload, that can perhaps be dated back to the 1998 Personal Medical Service (PMS) contract was introduced and the Government at the time pioneered the idea that GPs were a kind of catch-all for primary care.
GPs received a pay rise as part of the 2004 contract, but it has since flatlined, with both practice finance and GP pay eroding year on year.1 Even so, we have been punished for accepting it by politicians and the media, despite the fact its benefit has now evaporated.
Successive governments have demanded more from us without offering to pay for it or to shift existing workload. I have previously asked colleagues to give me examples where a shift of care has been followed by a shift of resources. The only two that anyone can think of are batch-prescribing and online appointment-booking, both of which save (a little) time.
Everything else has increased our workload. The insistence that perfectly healthy people ‘see their GP’ hauls demand for access to an unreasonable level and casts us in a role that we have never asked for.
GPs have now reached their tipping point. As Pulse has reported, GP burnout is more common than ever especially amongst partners, [Reference: , which reflects trends I have seen at PHP.2
The long view
Workload is a political issue. I’m tired of hearing people telling GPs to work ‘smarter, not harder’ – it’s a dreadful phrase that assumes if GPs reorganised themselves, they could do more. Only this week, a CCG leader asked me why the College isn’t doing more to get GPs involved in commissioning. The reality is that we are doing a huge amount to support GPs in this area but we know that some GPs simply don’t have the time to get involved. The College is too busy helping GPs operate under their current workload without adding to it.
The Government, policy-makers and think-tanks must recognise stress and workload issues crisis in the interests of patient care. We are more than 10,000 GPs short according to the Centre for Workforce Intelligence, which threatens the sustainability not just of primary care, but of the whole system.3 Whatever the vision for the NHS, GPs are its foundation. No health service can survive without its ‘gatekeepers’.
The College plans to address the issue by setting up a programme through our faculties about increasing resilience, and workload concerns are part of our forthcoming vision of the future of general practice: 2022GP.
But my advice for GPs now is to look after yourselves. Set your own limits at work, build in times of respite and be open with colleagues about how you’re coping (or not coping). Make sure your patients understand what’s happening in general practice at the moment.
We make our jobs look easy but there’s no shame in sometimes admitting that we are having problems or that we need support.
Professor Clare Gerada is the chair of the Royal College of GPs, leads the Practitioner Health Programme and works as a GP in south London.
1 Pulse. McKinsey identifies need for 40% increase in GP funding. 11 November 2009
2 Pulse. ‘Shocking’ numbers of GPs seeking pastoral support, say LMCs. 28 January 2013.
3 CFWI. Shape of the medical workforce: Informing medical training numbers. August 2011