View from the ground by Dr Zoe Neill, GP

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The mental health of GPs is suddenly a hot topic. October 2016 saw the launch of a recruitment drive for the national occupational health service for GPs, with the Hurley Group (home of the award-winning Practitioner Health Programme) winning the national contract to provide treatment for mental health problems and addiction issues in general practice.

InnovAiT, the RCGP journal for education and inspiration in general practice, published a ‘Resilience Special’ in June 2016, with copies being given out at the RCGP conference; and there’s no shortage of other people speaking out about GPs’ mental health.

Mind, the mental health charity, published research in August 2016 that found ‘worrying’ levels of stress among primary care staff. Dr Johanna Spiers from the Bristol Centre for Academic Primary Care spoke at the RCGP conference about mental health problems in GPs, commenting that it’s more likely than not that your GP will be ‘burnt out’. Prominent GPs like Dr Zoe Norris and Dr Shaba Nabi have also publicly shared their stories about depression and burnout.

This coverage is good news for all kinds of reasons, not least because of the de-stigmatising effect that simply talking about mental health can have. Yet, while this discussion is to be celebrated and the provision of confidential mental health services for GPs is much needed, who is asking why this is happening?

Any jobbing GP will be able to tell you why.

Life as a GP is so busy and demand for their services is rising inexorably; people are living longer and with more long-term conditions, creating more medically complex scenarios. The burden of complaints and litigation is also increasing, and with it the cost of indemnity, which can preclude GPs from working OOHs. Asking why again could be helpful. What’s the root cause of rising demand and increasing litigation?

The work is intense and more demanding. With the added punitive observations from the CQC and GMC through appraisal and revalidation, life as a GP can feel unremitting. New buildings, stocked with several GP practices, have taken away the ‘water cooler moments’ and instead GPs are behind multiple uniform doors along long corridors. The only time a GP sees another human being who is not a patient is when they are brought yet more work that requires a decision. The buildings may be CQC compliant, but at what cost? Who really benefits? Has the CQC weeded out our most poorly-performing, dangerous colleagues? Has revalidation and appraisal caught another Harold Shipman? Where’s the evidence?

The industrialisation of medicine has stolen our quiet corners, our recuperative chats; our time to think. Junior doctors, trying to escape ‘to the community’, soon realise that general practice is not the utopia they seek, so GP training places go unfilled. General practitioners are retiring early and, just as worryingly, GPs with another two or three decades of work to do are hanging up their stethoscopes and emigrating, or working as locums with portfolio careers. Many GP chairs are empty. Practices are facing closure as ‘failed businesses’, and being the ‘last man standing’, with worries about staff redundancy payments or lease payments, does not help to attract new GPs.

You’ve heard most, or all, of this before; mindfulness classes, CBT, or time management courses are on offer as the panacea—but this is not just a problem for individuals, it is a systemic problem. The current system continues to deliver burnt-out GPs, recruitment problems, and collapsing practices. The system needs redesigning. We need to think carefully about what demand we’re meeting, why we’re meeting it, and how we using our finite resource—clinicians. It’s clear that the cavalry is not coming.

What we do know is that GPs are actually incredibly resilient. It is amazing that general practice is still going, still limping along. Anecdotally, it is apparent that each individual has their own tipping point, preceded by an anger directed at themselves and the system, which then evolves into an acceptance of their reality, followed by opting out—either briefly or permanently.

What we also know is that GPs can be amazingly innovative. They are used to responding to changes, and quickly. The change that a CCG delivers in 2 years, a GP practice can achieve in a week.

The question that remains is, how are we going to redesign general practice?