Strain of workload is taking its toll on GPs
Doctors, nurses and other healthcare professionals are just as susceptible to mental health problems as their patients. Here, Rebecca Payne from the Royal College of GPs explains why staff in general practice need to be protected . . .
Working in general practice can be incredibly rewarding. GPs are motivated by spending time face-to-face with patients and improving people’s lives.
It’s community-focused healthcare highlights the human side of medicine.
While this may be general practice at its best, it’s equally important to consider the other side of the coin.
GPs are under more and more pressure, trying to meet a workload that is quite simply unsustainable. What this means for the mental health of GPs cannot be ignored.
It can be hard to think of healthcare professionals as vulnerable, but the NHS is made up of human beings and human beings will inevitably have their vulnerabilities.
PRESSURES ON GENERAL PRACTICE
that The pressures facing general practice are increasingly well-known. In simple terms, demand is going up, but the supply of GPs is falling.
Cases are becoming more complicated – Wales has an ageing population and more people presenting with multiple chronic conditions – and in many parts of Wales we don’t have the capacity to match it.
The result of these pressures is that GP workload is soaring. Working days are becoming increasingly intense, and many GPs are reporting working 12 or 13 hour days as a matter of routine, either in practice or logging back in during the evening to finish the administrative work they didn’t get done during the day.
Delays in booking appointments will be familiar for many people, and it is a frustration we share with patients.
A GP running late is stressful for patients, but also for the GP, who will not just be worrying about the patient in front of them, but all those in the waiting room.
When the surgery is over the GP will need to squeeze in home visits and important administration, such as looking at blood results, before the next day begins.
Going home at the end of a working day can be accompanied by feelings of guilt that work has been left behind, but also concern that friends and family are being neglected.
Just like many of our patients, after a hard day at work it’s hard to have enough mental energy left to give proper attention to spouses and children, let alone find the PE kit, help with school projects or check on elderly relatives. The attitude of a GP is often to keep working until everything is done, but the truth is that workload pressures have got to the point where no matter how hard we work it can be impossible to provide the level of service we are truly happy with.
WHAT IT MEANS FOR A GP’S MENTAL HEALTH
There is a very real risk that these pressures can affect the mental health of GPs.
As a profession we are going above and beyond to try and meet demand, but working harder and harder – and working longer and longer hours – inevitably takes its toll.
One very obvious result is stress. In a ComRes survey commissioned by RCGP Wales, almost one in three GPs (32%) said they are so stressed they feel they cannot cope at least once a week.
Recently Mind Cymru published survey results which included mental health and general practice.
It found that 35% of GPs said they had personal experience of a mental health problem, while 12% of GPs said they use or have used mental health services.
Complaints can often act as a trigger for a deterioration in a doctor’s mental health; as fallible humans we do miss things, and it’s devastating.
Difficulty getting help from hospital services can add to stress, where patients are sometimes waiting months for services and coming back to the GP while they’re waiting.
It’s also stressful when a GP feels they have an inability to do anything about the reasons some patients come – for example people who the benefits system pushes into the health service rather than addressing their employment needs, or those who need an increase in social care rather than more medication.
Supporting patients through the most difficult times in their lives is emotionally draining.
If a GP speaks to someone who has lost a child or been diagnosed with cancer, and the next patient comes in with a minor issue that could have been dealt with by the local pharmacy or supermarket, it can be difficult to make the psychological switch to ensure they get the same level of compassion.
Of course, these pressures need to be set against all the good things about working in general practice.
Being part of a supportive team, feeling like you’re making a difference, having the satisfaction of making the right diagnosis and having supportive friends and family outside of general practice – they’re all things that make general practice great.
But we simply cannot ignore the pressures GPs are under, and what it means for their mental health.
WHAT IT MEANS FOR PATIENTS
The emotional and mental health of GPs – and other healthcare professionals – has an enormous impact on the overall health of the NHS and the services available for patients.
There are obvious implications if excessive workload leads to GPs leaving the profession, or reducing the number of hours worked.
It means an already stretched workforce becomes even thinner, with fewer appointments available for people who need them.
In 2016-17, 77% of people in Wales saw their GP. We are at the frontline of the health service and issues faced in general practice can ripple through the whole health service.
WHAT IS BEING DONE
Problems associated with excessive workload, and knock-on effects for mental health and well-being, are being recognised.
New ways of working in general practice are being developed, in part as a response to workload pressures.
Increasingly we are seeing nurses, paramedics, physiotherapists and other professionals working in general practice.
The most recent GP contract saw some of the bureaucracy in general practice stripped back, along with specific measures around workload and system change.
The Welsh Government talked about the importance of workforce well-being in its most recent strategy document.
Health for Health Professionals Wales has been set up to provide a counselling service for doctors in Wales.
However, progress is slower than we would hope.
These are steps in the right direction but the situation on the ground is still extremely tough, and truth be told it’s often difficult to see light at the end of the tunnel.
GPs need to see a dramatic increase in the pace of progress.
WHAT NEEDS TO HAPPEN NEXT
For GPs – and for patients – this is an important issue to get right.
Ultimately, there needs to be a concerted effort to relieve the pressures on general practice. The steps already in place need to go much further.
Wales has 136 GP training places, lagging behind where we should be. We would have 184 places if we were just to match the average training places to patient ratio from other parts of the UK.
RCGP Wales wants to see real ambition for general practice, aiming to meet the challenges we face with an increase to 200 GP training places.
We are also calling for measures that will help in the short-term, including measures to prevent GPs leaving the profession and building on work that sees other healthcare professionals working in general practice.
The best way to improve the mental health of GPs is to create a workforce capable of meeting patient demand.
It will help us realise what can be so rewarding about general practice.