I first realised I was burnt out when I was reduced to tears at work, after being asked to “squeeze in” an extra patient in my already overflowing clinic. I ploughed on, but the tears told me that I had reached breaking point.
Burnout is the physical, mental and emotional exhaustion caused by extreme and prolonged periods of stress in the workplace. Even before the pandemic, GPs and emergency department doctors had higher burnout scores than any other group of doctors. Now things are even worse, with burnout rates 20 per cent higher and an average of three GPs leaving the profession every day.
The demand is unrelenting. GPs are routinely working 12-15 hour days, reporting 40 or more patient contacts – way above what is considered safe. In March last year as the pandemic hit our shores, NHS England mandated the move to “total triage” in primary care to limit the spread of Covid-19, protecting both patients and staff. Almost overnight, we moved to remote telephone, video and online consults, establishing hot hubs to enable ongoing face-to-face contact if the clinical need arose.
We delivered, at short notice, 75 per cent of a mass new vaccination programme. We dealt with the backlogs resulting from cancelled secondary care work. Data from NHS Digital confirms, contrary to the reports of being closed, general practice was and is busier than ever before. Despite this, we are being shouted at by patients frustrated with delays, and being vilified by large sections of the press. This all takes its toll and GP suicide rates are now four times the national average.
I didn’t go into medicine to defend myself against untruths that general practice has been closed for 18 months (we really haven’t). I’m trying my best and working my hardest to advocate for patients in a chronically underfunded system. If I was able to simply do my job and focus on practising medicine, I could do it. But we are bombarded with so much more than clinical care on a daily basis. Then after a 13-hour day, returning home to see social media comments about GPs refusing to see patients when you’ve just seen, spoken to, or messaged 80 in that one day alone.
Our leaders are unsupportive. NHS England has informed GPs about changes in their contract via the newspapers, and the government claims to provide more funding in general practice, but attach so many strings about when, where, and how it can be spent, when actually most practices just need an extra GP or practice nurse to help take the strain.
We’re constantly hearing that we need to be resilient. Resilience is being able to recover from setbacks without brooding on them; to bounce back from pressure to your starting position. It’s not about working harder with fewer resources, or being able to shrug off abuse. Elastic is very resilient – it stretches a long way, then bounces back to its original form. But even elastic will snap if too much pressure is applied. And this is what is happening to GPs right now. We stretched and now we are getting dangerously close to breaking. And as I found, it’s only going to take one more request, one more adjustment, one more hurdle, before we snap. Every GP who burns out is one less GP to see patients, to advocate, and to care for them. It has already started, and it will continue unless things change.
I didn’t want to have time off. The guilt of burdening my colleagues and abandoning the patients I was caring for was overwhelming – I would be letting them all down. But I was going to break if I didn’t stop and take time to heal away from the unrelenting pressures of the current climate.
Burnout can be eased with medication or time off, but ultimately, for someone to recover, there needs to be changes within the workplace that caused the condition to start with. The entire system needs to change. The workload of individual clinicians needs to be reduced to a safe level without adversely affecting patient care, and to do this we need more funding, alongside more vocal support from government and leaders. If we don’t make changes, there won’t be any GPs left to see patients.
Dr Rosie Shire has resigned from her NHS GP job