Dr Honor Merriman explores how to help GPs before they reach burnout and provides practical steps for supporting colleagues and improving morale

Honor Merriman

Dr Honor Merriman

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Read this article to learn more about:

  • three core workplace needs that impact the wellbeing of doctors
  • how mentoring schemes can support GPs through challenging times
  • compassionate leadership and how to achieve it.

It comes as no surprise that burnout in doctors decreases the quality of care offered to patients.1 The risks associated with overworked and unwell doctors, both to patients and doctors themselves, are significant and concerning. To mitigate these risks, the General Medical Council (GMC) has published Caring for doctors, caring for patients, which includes the results of an independent review of the causes of poor wellbeing among doctors and recommends several ways in which these issues can be addressed.2

As a GP appraiser, I have become increasingly concerned in recent years about the wellbeing of my peers. Appraisal meetings often begin on a positive note, as GPs present their achievements over the previous year. These are usually considerable, with many finding new ways to tackle increasing demand with dwindling resources. I am amazed at the number of those who stay well by taking exercise on top of a 12-hour day—where do they find the energy? However, not everyone is superhuman. The relentless negative feedback we receive from the media and general public, in combination with poor communication with our secondary care colleagues, have led to low morale. The number of GPs leaving the role is increasing, and of those who stay, many are demoralised. Quite often, there are tears in the appraisal discussion; although this provides catharsis, it does not lead to the difficulties being resolved.

We have heard politicians promise many times that we shall have more GPs. It sounds good to the public; however, in reality, increasing the number of GP training places, or stepping up the recruitment of doctors with equivalent qualifications from overseas, is unlikely to attract the number needed. Our daily tasks are so often thankless and endless—so very much needs to change.

What does the GMC suggest?

In the GMC’s very detailed review, the authors have identified three core workplace needs that impact the wellbeing of doctors. These are the “ABC of doctors’ core needs”:2

  • autonomy/control—to have a voice in the workplace, better work conditions, and manageable work schedules
  • belonging—to have a sense of community, effective team working, supportive leadership, and an inclusive culture that takes into account the needs of all
  • competence—to be able to deliver valued outcomes, such as high-quality care, because workloads do not exceed the capacity of staff to deliver them.

The review provides several inspiring, GP-based case studies. I particularly like the section on compassionate leadership, which can be achieved by being understanding towards, empathising with, and helping one other.2 This is not just the responsibility of GP partners and practice managers, but the joint responsibility of all in the practice team. Being understanding includes:2

  • seeing that suffering is often masked by missed deadlines, errors, or difficult work situations
  • learning to be curious about the causes of difficult or ambiguous work situations
  • cultivating the default assumption that others are good, capable, and worthy of value
  • withholding blame by focusing on learning
  • giving others dignity and worth whatever their role or difference.

Empathising includes:2

  • being present
  • remaining calm and steady in the face of suffering
  • developing empathic listening, allowing leaders to be present without needing to fix, solve, or intervene necessarily
  • identifying with others by feeling similar.

Helping includes:2

  • focusing on what is most useful for the other
  • taking action that addresses suffering
  • creating flexible time to cope with suffering, buffering others from overload
  • avoiding legalistic approaches that deny human connection
  • addressing corrosive politics, toxic interactions, underperformance via ‘fierce compassion’
  • empathising, integrity, and confidentiality
  • recognising that compassion is neither weak nor vulnerable.

How can GPs help each other?

The culture change described in the GMC document is already present in some GP practices—those that make time each day to discuss problems together, those that have open doors to each other however busy the day is, and those that check each other’s workload, so that if one team member is facing a complex clinical problem, everyone lends a hand. These practices also learn and participate in social activities together.

Mentoring schemes

Not all GPs can be part of practices that do these things. Furthermore, some GPs need help because of particular problems, which may be work based or home based. GPs are as likely to have relationship or money problems as their patients. Some experience poor working conditions due to poor premises or workplace bullying.

Many areas have set up mentoring schemes. This is not new: local medical committees have been proactive in providing support in several areas. At last, we have been able to set up a mentoring scheme in Thames Valley, which was launched recently. During this process, we were able to find out what has worked elsewhere and what has not. Not being an ‘early adopter’ was not our choice, but it has been advantageous in this respect.

Our scheme is unique in that the mentors are all GP appraisers. When discussing the scheme during the set-up phase, a few local appraisers felt that we wanted a different type of meeting, in which we did not need to count up continuing professional development (CPD) credits or completed audit cycles. We wanted to listen in such a way that we could understand our peers and they could understand themselves. We wanted to encourage them to voice their story and thus find a way forward. We felt confident that local appraisers had the necessary skills already, but needed to set up meetings outside of appraisals: confidential discussions with no outputs that needed to be uploaded to the Revalidation Management System!

To achieve this, we are supplementing the existing skills of GP appraisers with additional training and regular supervision sessions. At a recent session, we were asked to consider whether we listened to understand, or with the intent to reply. We learned that: ‘Listening is much more than allowing another to talk while waiting for a chance to respond … The beauty of listening is that, those who are listened to start feeling accepted, start taking their words more seriously and discovering their own true selves.’3

The local mentoring scheme has developed a website with lots of resources; just visiting the website answers many questions without the need for a face-to-face meeting.4 We encourage first contact to be made via the website because we feel that a phone call may deter some from seeking help.

This account may read as a self-congratulation, but it is not intended as such; rather, we want to share details of our website, with its ‘Signposting and useful resources’ feature under the ‘Learn more’ tab, as something that could be useful to all GPs. In addition to the mentoring programme, there are career support programmes and a local locum chamber (run with the National Association of Sessional GPs). Links to these resources can also be found on the mentoring website.4

‘O Wind, if Winter comes, can Spring be far behind?’5

What else is happening now that may help us? It is possible to see how innovations in some areas can help all of us.

Pharmacists are now working in many practices. Their training makes them skilled at reviews of medications and long-term conditions. Reconciliation of patient medication—necessary after hospital discharge, for example—can be undertaken effectively by pharmacists working alongside GPs.

Primary Care Navigators are also now working in many practices. They have the skills to advise patients and their families about available resources, both in social care and in the voluntary sector. They work closely with social prescribers, who can help patients by focusing on what matters to them and by taking a holistic approach to people’s health and wellbeing. They connect people to community groups and statutory services for practical and emotional support.

Nurses, paramedics, and physician associates are already providing valuable help in GP practices, most commonly by offering minor illness clinics.

All these things are happening now, before we even mention e-consults and video consultations. Using information technology (IT) alone may promulgate the inverse care law, in that those who are more fluent with and have better access to IT may receive more GP attention than those who are less IT savvy. However, using new IT approaches alongside more traditional ways of communicating with patients can extend the services offered to patients. It can improve access to care to those at work, or those at home with caring responsibilities.

The future can be bright if we are willing to look at different ways to provide care. It will be even better if we consider the wellbeing of those we work with. We need to listen more, so that we understand each other better. Together, we can change the world.

Dr Honor Merriman

GP Appraisal Lead Thames Valley

References

  1. Tawfik D, Scheid A, Profit J et al. Evidence relating health care provider burnout and quality of care: a systematic review and meta-analysis. Ann Intern Med 2019; 171 (8): 555–567.
  2. West M, Coia D. Caring for doctors, caring for patients. London: General Medical Council, 2019. Available at: www.gmc-uk.org/about/how-we-work/corporate-strategy-plans-and-impact/supporting-a-profession-under-pressure/UK-wide-review-of-doctors-and-medical-students-wellbeing?dm_i=OUY,6JSJD,5IZO0V,Q19KG,1
  3. Henri Nouwen Society. Listening as spiritual hospitality. henrinouwen.org/meditation/listening-spiritual-hospitality/ (accessed 18 December 2019).
  4. Perform Learn Develop Ltd. GP mentoring. www.gpmentoring.co.uk/ (accessed 18 December 2019).
  5. Poetry Foundation. Ode to the West Wind by Percy Bysshe Shelley. www.poetryfoundation.org/poems/45134/ode-to-the-west-wind (accessed 18 December 2019).