View from the ground, by Dr Honor Merriman
As GPs we are privileged to know and be trusted by our patients. Those of us who also work as GP appraisers have an additional privilege because we meet amazing colleagues who share their thoughts and aspirations with us. They achieve so much for their patients in the face of what feels like an increasingly insuperable workload. Surveys suggest that 4 out of 5 GPs intend to resign within the next 5 years and this state of mind is becoming apparent in GP appraisals.
Let me tell you about an amazing local GP—one of my appraisees. She works 12-hour days. Her practice has recently been rated ‘good’ by the CQC; she has worked hard to streamline the work of the practice; and she is a key member of a strong practice team. Her pre-appraisal paperwork told quite a different story; she wrote: ‘I think I work unsafe days with inadequate breaks and take too many decisions, some of which are undoubtedly poor by the end of a difficult day—is anyone interested?’ and‘I recognise early signs of burnout when compassion is suppressed by other factors at play’. There was more but this is a flavour of what the best of us are feeling now.
What can we, as appraisers, do to support GPs who are feeling this way? In an appraisal discussion, it is important to focus on what might be troubling the GP right from the start and facilitate a discussion that allows exploration of different options that can put the GP back in the control of their life. The other tasks of the appraisal discussion can happen later.
At a recent GP appraiser update meeting, we identified a selection of other resources that help promote GP resiliency and support colleagues who are struggling:
- local groups that provide informal support (perhaps consider setting up one in your own practice)
- programmes run by the NHS Leadership Academy
- Balint groups
- National Association of Sessional GPs
- Lead. Manage. Thrive! courses, run by Red Whale
- RCGP First5 groups (why aren’t there groups for ‘The Last5’ and the ‘Squeezed in the Middle GPs’?)
- RCGP courses on resilience and the General practice forward view in action
- Ten Commandments for the resilient practitioner, by Simon Tobin and Neal Maskrey
- the Resilient GP Facebook group.
On 30 January 2017, the NHS launched a new GP Health Service. This self-referral service is aimed at helping GPs (and GP trainees) with issues relating to a mental health concern, including stress, depression, or an addiction problem, particularly where these might affect work.
I have shared these sources of help in the hope that someone reading this article will benefit. I am left with a fear; if the NHS remains under-resourced and the Prime Minister continues to regard GPs as a target for blame, at what point will even the bravest and strongest of us say ‘enough is enough’?