Rebuild General Practice spokesperson Dr Jess Harvey on how GP burnout and the workforce crisis are inextricably linked
For years, GPs have been desperately trying to plug holes in the sinking boat of general practice. We’ve seen the number of full-time equivalent GPs decrease, patient lists increase, funding stay stagnant, and practices closing. We’ve known from the very start that this kind of practice is unhealthy and unsustainable, leading to unhappy patients and burnt-out doctors. While successive governments have come up with plans for how to recruit more GPs into the NHS, they’ve also made the glaring omission of figuring out how to keep GPs in the NHS.
Worryingly, we are seeing extraordinarily high levels of burnout across general practice. According to Pulse publisher Cogora’s workforce white paper published in January, 50% of GPs report symptoms of burnout, with stress levels higher than at any point in the last decade. This did not happen by coincidence. With dwindling funding over the last decade-and-a-half, practices find it increasingly difficult to hire replacements due to financial pressure. As a result, doctors are doing more work than ever, but not seeing the support they need to handle their cases with care and time. It’s currently a race to survive – not to deliver the best care possible.
This situation is not slowing down. Despite the health secretary’s recent funding announcement, GPs are leaving the profession in droves, leaving drastically low levels of full-time equivalent GPs. This is leading to increased wait times for patients and reduced continuity of care – a tenet of general practice we know is really important for our patients. As a result, patient outcomes are suffering. GPs being overworked creates a vicious cycle, whereby we struggle to provide care the way we know we can, want to, and should. It’s unfair to us and it’s unfair to those who seek our care and expertise.
But the situation doesn’t have to be like this. The health secretary’s increase in funding is a welcome start but it’s not enough – especially with the increase in National Insurance employers’ contributions due to kick in soon. We need money to be able to hire enough staff so that GPs are not working unsustainable hours and can deliver patient care to the highest quality. The reality is that more money would lead to less pressure – and less pressure leads to better patient outcomes and a stronger general practice.
In addition to unlocking more funding, we need stronger policies that reduce the unnecessary admin burden facing GPs. Our profession was made to cater to patients – to work with people; not stacks of paper and online forms. We don’t need a major upheaval in the way processes run. What we need are common sense solutions that allow us to do our jobs, while keeping the important communication channels with other parts of the NHS running smoothly.
We need to protect the mental health of GPs if we want general practice to have any chance of surviving. Without GPs, we don’t have a profession, and without this profession the NHS and its patients will suffer greatly. The Government cannot operate as previous governments have by sweeping this under the rug. We need to see concrete changes to ensure that our doctors are protected and our patients receive the high-quality care they deserve.
Dr Jess Harvey is a GP in Shropshire and Rebuild General Practice spokesperson
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The trouble is it’s not just the situation in general practice that affects us as GPs.
I feel increasingly – with waiting list for many specialites approaching a year long, admissions with no clear diagnosis and plan on discharge and often unhelpful A+G responses – that we are operating without any significant secondary care backup.
It feels unsafe and adds to the underlying pervasive sense that we are not providing a good service to patients.
Patients dread going to A+E and I understand why as it feels like war zone when I have gone with family members.
All of this – along with the feeling that as GP’s we can just be replaced with staff members with much less qualifications ( but we take the risk of course) adds to the burnout situation.
More money in general practice – with of course no guarentee that it will lead to employing useful staff rather than jsut increasing partner share – is not the whole answer.
how sad this is. I recently retired and it was a different world in our practice. Each partner specialised in one clinical area and we referred a lot amongst ourselves. Our hospital referral rates were far lower than average and because of our specialist knowledge we never had any queries about the validity of them. We worked quite hard and saw a lot of patients but the stress levels were low and we all worked full time and enjoyed the job, and the patients were extremely appreciative.
Then came protocols and guidelines and trial by retrospectroscope against the smallest of small print and notes had to become templates and the computer system filled up with junk negative findings. PCNs took over a lot of the funding and we suddenly no longer had enough room for all the ancilliated workers and partners started to go part time. I was fortunate enough to work when english general practice was a vocation and it saddens me to see how it has been picked to pieces…..
Spot on Jonathan
JH, I identify and completely empathise with the picture you paint. Successive neolibs, Labour and tory, have intentionally deprofessionalised and proletarianised doctors (and teachers etc). And your final paragraph describes some of their methods. It’s to the purpose of costcutting and disempowerment (easier to then privatise) leading to despair such that newly qualified GPs seek to go abroad. Working in general practice used to be fantastic.
The BMA should call a strike, a protest march etc, not for the contract reason but to fight to save traditional professional general practice which is on the tipping point of extinction. And if this battle goes unfought, nobody will be able to remember, in the future, how beautiful a “sherlock homes-ian” medical “specialty” general practice used to be..