A former practice manager has used her experience working in general practice as the basis for a contemporary novel that shines a light on stress and burnout in primary care.  She tells Julie Griffiths more

General practice is an unusual setting for a romantic novel, but it’s the environment that novelist Alice May chose for her new book The Mid-Life Trials of Annabeth Hope. And Alice has plenty of experience to draw on after spending two decades as a practice manager in Dorset.

Alice includes the pressures of working in a GP surgery in her novel, a romance set against the backdrop of stress and burnout and hopes her book will raise public awareness of what it’s like to work in primary care. 

‘When I have conversations with people who are non-medical, it’s always struck me as interesting how little they understand about what happens behind the scenes. I was hoping the book might raise a bit of sympathy towards the complexities of the system within which our medical staff are working,’ she says.

In the novel, Alice explores how the stress of general practice can take its toll. One of her protagonists is a mid-life GP who is suffering from burnout and has a mental health crisis. He runs away from his old life and ends up in the New Forest, living next door to the titular Annabeth, who has no experience of working in general practice. As romance blossoms, the two characters help each other despite opposing viewpoints and different approaches to life.

The inspiration for the plot came from a real life incident that Alice heard about where a GP jumped from a ground floor window mid-consultation due to stress. Although Alice did not know the individual involved, the idea germinated: ‘It made me wonder what situation would have built up for a GP to get to that point. I was really struck by the serious nature of burnout among medical staff.‘

Alice was particularly keen to challenge one of the tropes commonplace in TV shows and films – something she calls ‘the Doctor Kildare effect’, which refers to a 1960s medical drama.

‘It’s the attitude that doctors are superhuman,’ she explains. ‘They waltz in, fix the problem and waltz out again without it really impacting them. And that’s not what happens because doctors take it home with them at the end of the day.’

Alice became a practice manager when she and her GP husband bought Grove Surgery in Christchurch and built it from a tiny practice into one of the biggest in the town. She left in 2017 to become a full-time writer, and before writing the book, she talked to her former colleagues about the stress of general practice.  Alice also gave them early drafts of the novel for feedback.

‘Some of the early drafts were a bit dark in terms of the mental health of my GP character so I had to dial back a little on that. But I still wanted to get across the sense of the things that might weigh on someone who is in burnout because, of course, if you are suffering from anxiety and depression, you’re not necessarily thinking straight. And then there is the additional stress of the threat of lawsuits and social media as well as CQC inspections and GMC investigations,’ she says.

Alice says a common aspect of burnout among those working in healthcare is that, ironically, they often fail to recognise when they are unwell. She believes this is partly because those working in a GP practice have a strong sense of being a team player. Nobody wants to let down their colleagues who face the same challenges and pressures, so even when the stress is becoming unbearable, there is a tendency for people to try to push through, she says.

Alice was keen to depict the ripple effect that this can have. For example, it makes the job of practice manager especially difficult: ‘As the manager, you have to make sure that the wheels don’t come off the business. You need your boss to look after themselves because ultimately, if they’re not functioning as well as they might, then actually it really could get very serious.’

Although the protagonist in her book is a GP, Alice is quick to point out that it is not only doctors facing burnout in general practice. Practice managers are at risk, too: ‘I don’t think we can just compartmentalise this as being a problem for doctors. I think it’s a problem for everybody within the NHS.’

This is why Alice believes self-care is essential for those working in healthcare, whether clinical or non-clinical. She says they need to look after themselves if they are to do their jobs effectively.  

Writing was a means for Alice to cope with her difficulties while working as a practice manager. In 2014, the family home she shared with her husband and four children partially collapsed and the insurance company refused to pay for the claim. For three months, they stayed in a tent in their garden before they replaced it with a caravan, where they lived for over a year until the problems were sorted.

It was a stressful event on top of an already stressful full-time job, and Alice admits that she ‘unravelled a little bit around the edges’.

‘That’s one of the reasons I started writing. I wanted to get my head around how we’d ended up in such a ridiculously awful situation.

‘I wrote about what it was like as a mother raising four children in a tent in the garden, trying to juggle work, trying to find builders, and trying to persuade the insurance company to help us,’ explains Alice.

Before she knew it, she had the first draft of a memoir. She went on to self-publish The House That Sat Down, which then led to another two books in the trilogy.

During that time, she continued running the practice, but she made time to write because the creative process was so helpful to her.

‘I’d get up early in the morning and do two hours of writing, then go to work. And then, maybe I’d be sat outside school waiting for the children and I’d write a little bit then as well,’ she says.

Alice believes creative activity can be a powerful means to cope with day-to-day stress, especially for practice managers who have a process-driven and detail-oriented job.

‘Practice management is very methodical because we can’t afford to let things slip through the net. I think creative activities enable your brain to float free so you can process things without actually focusing on them,’ she says.

Although Alice chose writing, there are myriad options, such as gardening, baking or painting. She says that the right activity gives relief rather than adding to your burden. There should be no pressure attached to it.

Next, Alice is working on a trilogy set in World War Two.  But she has not ruled out another novel set in general practice.

‘Goodness me, so much happens in a practice, doesn’t it? There are so many interactions on so many different levels and there’s an awful lot of practice life that could be explored. So, maybe I’ll return to it in the future.’