The guilt of of burdening my colleagues and abandoning patients was overwhelming. But I was going to break if I didn’t stop and take time to heal away from the pressures of the current climate

“I first realised I was burnt out when I was reduced to tears at work, after being asked to “squeeze in” an extra patient in my already overflowing clinic. I ploughed on, but the tears told me that I had reached breaking point.

Burnout is the physical, mental and emotional exhaustion caused by extreme and prolonged periods of stress in the workplace. Even before the pandemic, GPs and emergency department doctors had higher burnout scores than any other group of doctors. Now things are even worse, with burnout rates 20 per cent higher and an average of three GPs leaving the profession every day.

The demand is unrelenting. GPs are routinely working 12-15 hour days, reporting 40 or more patient contacts – way above what is considered safe. In March last year as the pandemic hit our shores, NHS England mandated the move to “total triage” in primary care to limit the spread of Covid-19, protecting both patients and staff. Almost overnight, we moved to remote telephone, video and online consults, establishing hot hubs to enable ongoing face-to-face contact if the clinical need arose.

We delivered, at short notice, 75 per cent of a mass new vaccination programme. We dealt with the backlogs resulting from cancelled secondary care work. Data from NHS Digital confirms, contrary to the reports of being closed, general practice was and is busier than ever before. Despite this, we are being shouted at by patients frustrated with delays, and being vilified by large sections of the press. This all takes its toll and GP suicide rates are now four times the national average.

I didn’t go into medicine to defend myself against untruths that general practice has been closed for 18 months (we really haven’t). I’m trying my best and working my hardest to advocate for patients in a chronically underfunded system. If I was able to simply do my job and focus on practising medicine, I could do it. But we are bombarded with so much more than clinical care on a daily basis. Then after a 13-hour day, returning home to see social media comments about GPs refusing to see patients when you’ve just seen, spoken to, or messaged 80 in that one day alone.

Our leaders are unsupportive. NHS England has informed GPs about changes in their contract via the newspapers, and the government claims to provide more funding in general practice, but attach so many strings about when, where, and how it can be spent, when actually most practices just need an extra GP or practice nurse to help take the strain.

We’re constantly hearing that we need to be resilient. Resilience is being able to recover from setbacks without brooding on them; to bounce back from pressure to your starting position. It’s not about working harder with fewer resources, or being able to shrug off abuse. Elastic is very resilient – it stretches a long way, then bounces back to its original form. But even elastic will snap if too much pressure is applied. And this is what is happening to GPs right now. We stretched and now we are getting dangerously close to breaking. And as I found, it’s only going to take one more request, one more adjustment, one more hurdle, before we snap. Every GP who burns out is one less GP to see patients, to advocate, and to care for them. It has already started, and it will continue unless things change.

I didn’t want to have time off. The guilt of burdening my colleagues and abandoning the patients I was caring for was overwhelming – I would be letting them all down. But I was going to break if I didn’t stop and take time to heal away from the unrelenting pressures of the current climate.

Burnout can be eased with medication or time off, but ultimately, for someone to recover, there needs to be changes within the workplace that caused the condition to start with. The entire system needs to change. The workload of individual clinicians needs to be reduced to a safe level without adversely affecting patient care, and to do this we need more funding, alongside more vocal support from government and leaders. If we don’t make changes, there won’t be any GPs left to see patients.”

Dr Rosie Shire has resigned from her NHS GP job

High levels of stress are severely harming the health of GPs and their ability to provide care for their patients, doctors have told MPs.

In a parliamentary briefing on 15 July representatives from the Doctors’ Association UK and the campaigning group GP Survival said there was a crisis of “unprecedented scale” in primary care that needed urgent attention.

John Hughes, a retired GP who now chairs GP Survival, said that the pressure on practices had intensified because GP numbers had not increased in line with surging demand, and ministers’ pledges to boost GP numbers had not been delivered. Constrained funding relative to the hospital sector, negative media coverage, and high levels of bureaucracy necessitated by the NHS and regulators had also contributed to GPs feeling burnt out, he added.

“GPs are leaving at a rate of three …

Read the full article here.

Some of those surveyed may have decided to return to their country of origin. However, the research also suggests a degree of frustration with the NHS among doctors. Reasons cited included red tape, workload, burnout, reorganisation, poor management, and tax on pensions.

Dr Samantha Batt-Rawden is an intensive care doctor and president of the Doctors’ Association UK. She says she’s not surprised that so many doctors are thinking about leaving the NHS.

Making Exit Plans 

“Many of my colleagues are actively making exit plans, whether that be retiring early, looking for jobs in other countries, or indeed leaving medicine altogether.

“Whilst most of us will have suffered moral injury and moral distress to varying extents during the pandemic, when you really listen to people about why they want to leave this is actually rarely mentioned. Instead, most people talk about deteriorating work conditions, and how this has made them feel,” says Dr Batt-Rawden.

Work-Life Balance 

“I think the need to feel valued as a doctor is what attracts so many to move abroad to practise medicine. Many doctors I have trained with over the years have left for Australia or New Zealand. It has been a real shame to lose so many talented and dedicated doctors, but they all seem so much happier there,” says Dr Batt-Rawden.

“There seems to be much more of a focus on work/life balance in the Antipodes. The hours are limited, there is a heightened awareness of burnout and fatigue. On-call accommodation is plentiful and it is often described as a much higher standard than what we have here (if we have it at all!). Trainees are given months of paid study leave for exams, the cost of which is also covered. Many doctors describe having thousands of pounds of a study budget a year which they are actively encouraged to use to broaden their horizons. The pay is much better too. All the doctors I know who have left for Australia for just one year have not returned, and it’s easy to understand why,” she adds.

The Future Post Pandemic

Dr Batt-Rawden believes the pandemic has unmasked many deep-seated problems or legacy issues.

“It’s become abundantly clear that there was very little practical support for frontline healthcare workers on the ground. These are simple things that are hugely damaging for morale – not being able to park at work, having nowhere to buy hot food overnight, not having a staff room because it has been turned into an office,” explains Dr Batt-Rawden.

She goes on to say: “I believe that there now is a desire to change these things, to reverse the slow erosion in working conditions that has happened so insidiously over many years. With many of my colleagues considering leaving the NHS, or indeed hanging up their stethoscopes for good, I can only hope that this isn’t too little, too late.”

The full article can be read here.

Senior GPs have called for a national inquiry after new complaints that patients are heading to emergency departments because they cannot get appointments.

GPs say they have been working harder than ever before – but are now facing “unprecedented levels of burnout.”

The Doctors’ Association has written to health secretary Matt Hancock, senior NHS officials and HealthWatch chair Sir Robert Francis.

The concerns surfaced after the publication of the latest emergency department data, showing the largest numbers in a year using hospital emergency services in March.

Emergency specialists attribute the increase to the easing of lockdown – but have also warned it will be unsustainable.

In the letter, two GPs Dr Elizabeth Toberty and Dr Ellen Welch state: “General Practice has been consistently underfunded over the last 10 years. Currently 90% of NHS contacts happen within primary care for less than 10% of the total budget. We desperately need a huge funding increase to aid much needed innovation, improvements in IT and infrastructure, and to increase staffing levels. 

“We urgently call today for a reduction in bureaucracy, a focus on GP burnout and staff retention, and most importantly an analysis into why patients are struggling to access care so we can work towards finding a solution that involves the whole health service working together.”

They add: “GPs are working flat out, and it is incredibly demoralising to find that our best is not enough. It is clearly not acceptable for huge proportions of patients to attend emergency departments when GP would be more appropriate. However, practices are working at and beyond full capacity which has led to unprecedented levels of burnout, sick leave and tiredness amongst GPs.”

Read the story on doctors.net here

In a letter to health and social care secretary Matt Hancock, along with the DHSC and Healthwatch – a statutory body representing patients – GPs from the Doctors Association UK (DAUK) warned that for frontline GPs, demand is ‘going through the roof’.

The group called for an urgent review after a Healthwatch report that highlighted a rise in negative feedback about GP services around the time national COVID-19 lockdowns were imposed.

The Healthwatch report said that while for many people experiences of general practice had continued to be positive through the pandemic, others had reported concerns around booking, remote consultations and access to regular checks and treatment. It highlighted ‘concerns that this would result in extra pressure on emergency services’.

GP workload

However, DAUK’s GP committee warned that if the current colossal workload being delivered in general practice was ‘still not meeting demand’, the government and NHS England must investigate.

NHS England said last month that general practice is currently delivering around 7m consultations a week including work on COVID-19 vaccinations – up around 1m appointments a week from pre-pandemic levels.

This figure is likely to be an underestimate, because data from NHS Digital do not fully reflect the number of telephone consultations in general practice – and GPonline has reported on RCGP surveillance data that show GP practice workload far outstrips pre-pandemic levelseven before COVID-19 vaccination work is taken into account.

The DAUK letter said the Healthwatch report confirmed that ‘the health of the population is suffering as general practice is drowning’.

Remote consultations

The letter said: ‘If primary care is having contact with 10% of the population each week and this is still not meeting demand there must be an urgent review to find out why.

‘The introduction of e-consults has made us more accessible than ever, and has opened the gates to a lot of trivia, which still uses GP time and resources, sometimes inappropriately. GPs are working flat out, and it is incredibly demoralising to find that our best is not enough.’

The letter said it was unacceptable if large numbers of patients were attending emergency departments for care available from their GP practice. But it added: ‘Practices are working at and beyond full capacity which has led to unprecedented levels of burnout, sick leave and tiredness amongst GPs.

‘General practice has been consistently underfunded over the last 10 years. Currently 90% of NHS contacts happen within primary care for less than 10% of the total budget. We desperately need a huge funding increase to aid much needed innovation, improvements in IT and infrastructure, and to increase staffing levels.’

The letter called for reduced bureaucracy, measures to address GP burnout and staff retention, and a review into access ‘so we can work towards finding a solution that involves the whole health service working together’.

Read the GP Online article here

UNDERFUNDED GPs
Sir, Your report “More patients go to A&E after ‘struggling to see GP’ ” (Apr 17) is a huge concern, confirming that the health of the nation is suffering as general practice is drowning. Our experience as frontline GPs is that demand is going through the roof. Compared with pre-pandemic levels, primary care — GPs and community services, rather than “secondary care” involving hospitals and specialists — is offering a million more appointments per week while carrying out 75 per cent of all Covid-19 vaccinations and the largest ever flu vaccination programme to date. The introduction of online consultations has made us more accessible than ever. However, general practice has been consistently underfunded over the past ten years. At present primary care accounts for 90 per cent of NHS patient contact time, but receives 10 per cent of the budget. GPs are burnt out and working beyond full capacity. Despite this, if we are clearly not meeting the needs of our population there must be an urgent review to find out why, and a national discussion on how we want to fund our health service.
Dr Ellen Welch
Dr Lizzie Toberty
Doctors’ Association UK

Read the letter here

DAUK’s Dr Natalie Ashburner & Dr Richard Gilpin in Health Europa Quarterly discussing the impact of COVID-19 pandemic on the welfare of healthcare staff.

April 2020, DAUK conducted a survey of 350 healthcare workers which found that 57% felt so stressed they have bene overwhelmed or unable to cope because of pressure at work during the last month. 
11% had felt suicidal and 3% had self-harmed in the past month because of stress from increased pressure at work. 

October 2020, DAUK surveyed >800 GPs:
– 78% working during the Pandemic had impacted negatively on their mental health
– ‘My mental health has reached the stage where I have even thought about crashing my car on the way to work’ 

Despite all the evidence of the mental health impact of COVID-19 in health and social care, little will change while the same mismanagement, slowness to react and lack of communication continues to dominate the decisions taken by those in charge.

Access the full article here

The NHS is facing a chronic shortage of GPs, as new figures show family doctors are quitting at a rate of three a day.

GP surgeries in England lost nearly 300 full-time doctors in the three months before Christmas, according to official NHS stats.

They were over-stretched even before the pandemic – expected to take on more work with no extra time to do it.

And now the extra pressures of Covid-19, including helping to deliver Britain’s world-beating Covid jab rollout, have left many facing burnout.

New doctors can’t be trained quick enough to replace them – with a shortfall of 7,000 GPs expected by 2023.

Professor Martin Marshall, Chair of the Royal College of GPs, said: “GPs and our teams want to provide safe, high-quality care to our patients and we can only do this with an adequate workforce. We desperately need more GPs working in the NHS.”

The figures, revealed in NHS Digital’s latest GP headcount, show the Tory government’s 2015 promise of delivering 5,000 new GPs by 2020 was a sham.

In fact the number rose by just 717 – from 34,429 at the end of September 2015 to 35,146 on December 31 2020.

And when looking at the number of fully-qualified permanent GPs – excluding locums and registrars – the number has actually dropped from 28,631 to 26,754.

Cheshire GP Dr Rosie Shire, a member of the Doctors’ Association UK GP Committee, said: “It isn’t surprising GPs are leaving the profession. My personal experience is that GPs are burning out through increasing pressure, struggling with low morale and looking at alternative careers.

“We are also seeing colleagues dying from Covid-19. Mental Health services that support all doctors are seeing an increase in contacts from doctors struggling to cope.

“We have been advised we can reduce some non-essential work to enable us to support the Covid-19 vaccination programme, but it is hard to find what part of General Practice work is non-essential?

“Smear tests, diabetes reviews, and baby vaccinations still need to happen to ensure we help people stay as well as they can.

“We were maxed out before the pandemic, and now we are struggling.”

She added: “When the pandemic hit the UK GPs had to change the way they operate virtually overnight.

“We are only too aware the limitations of remote consultations via telephone, video and email, and we still need to call patients to the surgery for face to face appointments.

“Remote consultations involve extra risk, so the GP needs to be even more thorough in the consultation to make sure they understand the problem and communicate the suggested treatment plan.

“This often takes longer than the standard 10 minute GP consultation, which was woefully short to begin with.

“All the staff in General Practice are working as hard as they can, and 5,000 extra GPs on the ground in 2020, would have helped ease the pressures created by the worldwide pandemic.

“Along with other frontline workers, we are struggling to get chance to rest and recharge. At the moment it feels like there isn’t any let up.”

Read the article in full here: https://www.mirror.co.uk/news/uk-news/fears-doctors-suffer-burnout-nhs-23498066

Medscape UK’s latest online survey of more than 1000 doctors highlights how working through COVID-19 has impacted their mental health and personal lives.

The number of doctors reporting burnout increased to 37% this year from 22% when we last asked in 2018.

“This latest survey absolutely aligns with what the Doctors’ Association UK is hearing from members,” commented Dr Natalie Ashburner, wellbeing lead for the Doctors’ Association UK (DAUK).

“NHS staff were already suffering from high rates of burnout and mental illness in the context of a decade of chronic underfunding of services, lack of staff, and erosion of pay and working conditions.”

Danger Pay 

More than half of doctors thought overtime or danger pay would be appropriate. Instead, most doctors in England got a 2.8% pay rise said to be in recognition of frontline work, but described as “a metaphorical slap in the face” by the British Medical Association.

As well as burnout, nearly 1 in 5 doctors said they were clinically depressed.

“COVID-19 has drastically exacerbated these pre-existing issues and the result is that dedicated, highly skilled staff have been pushed to the point at which they are unable to cope any longer,” Dr Ashburner said.

View the entire article here: https://www.medscape.com/viewarticle/940129

The Doctors’ Association UK (DAUK) is saddened to hear the results of the initial findings report of the GMC National Training Survey 2018. It details what junior doctors have been saying for many years, that they are burnt out, exhausted and often work beyond their rostered hours. In addition to this around a third of doctors reported that they had missed training opportunities due to rota gaps. At the time of the junior doctors contract dispute, grassroots doctors warned of burn out, understaffing and a lack of good quality training opportunities.

High pressure working environments have been seen throughout the NHS over the winter period, being described as a ‘war zone’ and ‘humanitarian crisis’. Unlike previous years, this pressure has not eased in the spring and summer, yielding a year-long crisis. Almost a quarter of doctors feel burnt out because of their work with 57% reporting that they are worn out at the end of a working day. About a third of doctors report lost training opportunities due to gaps in rotas.

Almost half the doctors who completed the survey stated that they have worked beyond their rostered hours. The safeguards set into the imposed 2016 contract of exception reporting are clearly not working to prevent the overworking of the doctor workforce. At a time where the contract is being reviewed, we call on all stakeholders to review the efficacy of the exception reporting process and address the real issues doctors face on the front line of rota gaps, overwork, fatigue and loss of training.

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