In the post-pandemic world, burnout and stress are becoming more of a problem for GPs. So, what can practice managers do to help? GP and wellbeing lead at MCG Healthcare Dr Matt Mayer shares some ideas
It is tough being in general practice in the current NHS climate and GP morale and wellbeing is at an all-time low. Contributing factors are unmanageable workload, dwindling workforce, and challenges in recruitment and retention. And all of this comes hot on the heels of the COVID-19 pandemic.
According to a Health Foundation report, GPs in the UK are faring particularly badly. They have the highest levels of stress and lowest job satisfaction compared with doctors in other high-income countries. The result is that colleagues are leaving the profession in their droves as the risk of burnout and physical and mental harm among GPs continues to rise.
The BMA says that burnout is a problem with working environment rather than the individual.
Practice managers therefore have the vital but unenviable role of watching for the signs of potential burnout and adjusting the environment to tackle this. They must support their GP colleagues as well as both from an HR and management perspective. And they have to do it while dealing with their own spiralling workload.
So how can practice managers go about supporting GP wellbeing and preventing burnout?
Signs of burnout
As a start, it would be helpful for practice managers to be aware of how burnout can manifest. They can be variable but some of the signs you might see in the workplace can include:
- Not taking pride in one’s work, taking the path of least resistance, cutting corners
- Irritability and combativeness with colleagues
- Fear of making mistakes, aversion to risk
- Lack of empathy with patients and colleagues
- Recurrent short periods of sick leave
- Becoming withdrawn.
On the face of it, these signs may look a lot like a performance management issue. This is arguably part of the problem. GPs by the nature of the job spend much of their day working alone in a consulting room and such an environment, coupled with the signs listed above, may lead to division and resentment. If there is a misconception that the person is to blame, this can further alienate the colleague in question and exacerbate the problem.
The first step should always be a supportive discussion with the colleague to ask if everything is ok, and if there is any way the practice can help. Avoid a tone that implies something is wrong with the individual; instead, focus on how the practice can provide support.
It may be that the colleague is clinically unwell and, if so, they should be signposted to their own GP as soon as possible. But until proven otherwise, assume that this is a problem with the working environment rather than the individual.
When it comes to making adjustments that might help, there are obvious changes to suggest such as reduction in hours or modification of tasks. But it is worth considering other options too, such as:
1.Ensuring variety of work
Varying duties for GPs and providing variety in the working week can help with wellbeing. One of the reasons many GPs go into portfolio careers is because the variety of different roles can provide relief from those that are more intensive. So, giving colleagues the opportunity to rotate through different sites, settings and duties is potentially useful.
2. Working in Teams
It would be hard to find a GP who relishes and looks forward to being duty doctor or on call, not least because of the isolation and feeling of being the last line of defence. So, buddying people up in such intensive roles or even (in large practices) having a larger team of staff responsible for the more intense work shares the workload and supports individuals.
3. Encouraging regular coffee breaks
It might seem obvious, but time to rest and cathartically unload to each other is invaluable and should not be underestimated. Some of the most supportive practices will carve out fixed slots in the day where the entire team sits down together for a break and social chat.
4. Offering mentoring
If a colleague is early in their career and struggling, then assigning a senior colleague to support and be available is a helpful protective factor. After all, GPs go from a training environment where they are mentored one-to-one with a senior they can turn to at any time to being completely independent. That can be a difficult transition.
5. Discussing a job plan
In my experience of GP representation, it always amazes me how few GPs have a clear job plan, which defines the limits of their role. This is contractually essential for salaried GPs but arguably essential for partners too in compliance with their partnership agreement. Sitting down and setting the parameters a role – what is and is not expected – sets clear boundaries and allows GPs to be more in control of their own workload.
All these measures can be effective in preventing burnout and supporting colleagues who are struggling. But it may be that a person needs help that goes beyond the remit of a practice. In such cases, GPs need to know there is help available and they should be encouraged to access it (see box.)
Practice managers may also wish to consider embedding wellbeing policies across the surgery. Even modest changes can have an impact. The RCGP has an Active Practice Charter and can provide simple and creative ideas to help.
It may be a truism, but prevention is better than cure – especially when it comes to burnout.
Resources practice managers can signpost to
Notwithstanding the above, there may be circumstances in which an individual requires help beyond what the practice/workplace can offer. In such cases, GPs need to know there is help available and they should be encouraged to access it. Such resources include:
- Their own GP – if a mental health or physical problem is likely then the colleague should be signposted to their GP as soon as possible. They may need treating and/or to be signed off sick.
- The LMC – every GP working in the NHS should have access to services by their LMC. LMCs are experienced and trained in pastoral care and support and are familiar with the signs of burnout and how to help. They may also be able to advise the practice on how to support colleagues.
- The BMA – regardless of whether the GP is a member of the BMA, any doctor can access the wellbeing services of the BMA. For non-members this includes a support line, and for members (and their families) it can include structured counselling courses.
- The NHS Practitioner Health programme – this is a free, confidential NHS service for doctors with mental health or addiction problems. It also has a text crisis line.
- The Cameron Fund – If a colleague has financial problems or hardship due to illness, they can be signposted to the Cameron Fund, which is a charity solely to support GPs.
Dr Matt Mayer is a GP, Wellbeing Lead at MCG Healthcare and chief executive officer at Berkshire, Buckinghamshire and Oxfordshire LMCs
