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Salaried GPs should speak to practices before reaching burnout, says BMA

by Julie Griffiths
24 October 2022

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Salaried GPs who feel ‘overwhelmed’ should have conversations with their practice before they leave the job, the BMA sessional GPs committee has suggested.

In an article on the BMA website last week, sessional GPs committee member Dr Paula Wright said that salaried GPs tended to leave jobs to protect their wellbeing without speaking to the practice.

‘Only too often salaried GPs will walk away from a job because they feel they cannot cope and cannot change the job. Once there has been an exodus, then the practice rethinks its approach to its salaried GPs,’ she said.

Dr Wright added: ‘Is there a better way to avoid this cycle of repeat attempts at recruitment and failed retention?’

She suggested that salaried GPs raise problems so they could be addressed by the practice. Workload, on-call commitments, feeling unsupported and unsafe were listed as factors for burnout.

‘Before walking away consider asking your employer to reduce or drop your on-call commitment, to increase appointment length or reduce contacts,’ she said.

Dr Wright set out suggested steps that salaried GPs could consider.

They include completing a ‘work diary’ to monitor the hours they work. If this exceeded the contracted hours, salaried GPs could discuss this with ‘a view to backdated remuneration and an amended job plan going forward’.

‘Only when the overtime is priced in terms of pay will employers see the opportunity cost of inefficient working practices like using clinicians to do work which could be done by non-clinicians or other clinicians, such as document management,’ said Dr Wright.

Salaried GPs could consider doing this as a group exercise with colleagues, she said.

Another way to strengthen workload boundaries would be for GPs to discuss ‘which activities within your work take priority’. Dr Wright suggested some activities could be dropped ‘until the employer has reassigned some of the excess work to another member of staff’.

This could include ‘incoming document management which admin staff can be trained up to do’ or ‘medicines alignment for discharges which could be delegated to a pharmacist’, said Dr Wright. Other tasks that could be dropped include the completion of private medical reports, supervision or teaching of students or trainees.

Earlier this month, BMA and Institute for General Practice Management (IGPM) called for a change in how practices manage their workload, including ‘deprioritising’ aspects of their day-to-day activity.

It came as NHS England’s board admitted that demand for GP appointments is at record levels and ‘outstrips’ capacity.

Other steps that salaried GPs should consider include:

  • Asking their employer to ‘reduce or drop’ their on-call commitment, increase appointment length or reduce contacts
  • Asking whether the employer is ‘fully utilising’ locum cover for absences. If not, thinking about whether this is causing them ‘excess workload’ with ‘prolonged hours or unsafe intensity’
  • Checking whether they are contractually required to provide absence cover ‘beyond the immediate emergency’ of 24-48 hours
  • Thinking about whether the practice’s appointment system allows them to follow up on their own patients, which is ‘important not just for safety and doctor and patient satisfaction but also is protective against burnout’
  • Thinking about opportunities to join in with ‘informal gatherings and discussion within the practice’ – or whether the ‘work intensity’ prevents this
  • Checking whether their job plan includes ‘mentoring or supervision which is not being offered’