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I don`t normally revisit a subject more than once in a while, but breaking news has caused me to look again at stress in General Medical practice from a different angle. If you visit the NHS Choices website, you will find the following advice on stress –
- Work out what makes you stressed and how you behave/react in these circumstances. Think of ways in which you can manage those pressures so that you can deal with them in different ways.
- If you are worrying about things beyond your control - try not to. Instead think about things that are within your control e.g. your workload, or your time off. Learn to say 'no'.
- Make a list of new priorities that you can do something about. Make a list of the stressful things in your life and a list of what would make life less stressful.
- Prioritise enough time to do some exercise everyday and to make sure you are eating healthily and getting enough sleep.
We`ll come back to that in moment, but I think it is poignant, given the results of the Department`s own survey of the GP workforce concerning stress and satisfaction. The proportion of GPs aged under 50 expecting to quit direct patient care in the next five years increased to 8.9%, the poll found. This would mean almost 2,000 GPs in this age group quitting the profession. Among GPs aged 50 and over, the proportion expecting to quit direct patient care in the next five years rose to 54.1% - around 7,000 GPs lost to the profession. In total that is 21.5% of the workforce!
The Seventh National GP Worklife Survey, commissioned by the DH and carried out by the University of Manchester, found rising workload, paperwork and a lack of time to 'do the job justice' were the top three factors contributing to increasing stress among GPs. On a scale of one (extremely dissatisfied) to seven (extremely satisfied), GPs' mean satisfaction score was 4.54, the lowest since a 3.96 average score in 2001. According to PulseOnline, Almost a quarter of GP partners work 12 hours a day or more, and more than 80% work at least 10 hours each day. One London GP said: ‘I am single-handed with a list size of 3,500 patients in a deprived area of inner city London. Even if 2% of my patients want to see me for 10 minutes it would be almost 12 hours without any breaks. How can one cope and one survive in this silly situation? The options are to retire or die of a heart attack!’
Further significant findings from the poll include –
- A total of 86% of GPs reported considerable or high pressure from rising workload, 81% from paperwork and 78% from having too little time to do their job justice.
- Among GPs who took part, 95% of GPs said they had to work 'very intensely' and 84% said they had to ‘work very fast’.
- The level of overall job satisfaction in 2012 was lower than in all surveys undertaken since 2001. Just over half of respondents (57%) reported being satisfied with their job overall in 2012, while 23% were dissatisfied.
- On a scale of one (extremely dissatisfied) to seven (extremely satisfied), GPs' mean satisfaction score was 4.54.
What are the main causes of this increased dissatisfaction with the job? On asking, doctors are quoting spiraling patient demand, an increasing ageing population, and cuts in resources. They also talk about recent increases in targets and `pointless` box ticking which have added another level of bureaucracy to General Practice that is diverting valuable time away from treating patients. A staggering 15% also admit to taking work home, even after these busy days.
Going back to the advice on the NHS website, As GPs, it is very difficult to view this from the inside, but if you could write down what aspect of work makes you stressed, in what way could you manage that pressure to deal with it in a different way? A number of practices are trying to find innovative ways of changing the working process. A few of these different mechanisms are aimed at working as productively as possible, but with less call on time. Such as –
- clinical triage,
- opportunities for patients to have e-mail or telephone consultations
- same-day walk-in services.
So is this leading to a possible mass exodus from General Practice? Well, my gut feeling is that the older age groups will probably be seeking earlier retirement, but younger GPs are going to struggle to find alternative workplace roles. Locum agencies are going to have a grand time though, as Practices and Practice groups struggle to man the hours needed. There is certainly going to be a growing nomadic tribe of registered doctors filling in the holes as they open up.
Support services for stressed GPs are available, provided mainly by deaneries and the BMA.
Deaneries run professional support units (PSUs) - some of which are available to doctors throughout their career - and they provide a varied mix of help with career development and wellbeing support. The PSU, run by the London deanery, for instance, offers psychological assessments and support; coaching and mentoring; courses for GPs on management, record-keeping and communication; and careers support, including occupational psychology.
The BMA provides a 24-hours-a-day, seven-days-a-week counseling service, and a doctors for doctors service offering medical advice. Its website includes a ‘burnout test’ to assess the effect of long and grueling working days, and it has just completed a one-year pilot providing emotional support for doctors facing GMC fitness to practise cases.
Dr. John Shapter – QCS GP Expert Contributor