Exclusive: Most GPs say their job has become more stressful

More than three-quarters of GPs say their job has become more stressful in the last year, an exclusive GP survey has found.

A huge 77% of GPs said their stress levels had risen over the past 12 months, and almost a third said their job had got increasingly stressful in just the last five months.

Almost 750 GPs responded to the survey, which also revealed that one in five GPs works 12 hours or more a day, and 40% complete more than 40, and up to 60, patient consultations every day.

One Cambridgeshire GP told us: ’50 [consultations] is about average, but as duty doctor I am now making 60-plus consultations. Earlier this week I made 75 patient contacts and managed over 100 clinical problems.

‘The intensity of the work, including all the fallout from recent changes has spiralled out of control. I am very resilient, but will solve this problem by leaving the profession seven to 10 years earlier than I should. What else can one do?’

Our workload survey found that GP partners were working even more punishing hours than salaried and locum GPs.

Almost a quarter of GP partners work 12 hours a day or more, and more than 80% work at least 10 hours each day.

One London GP said: ‘I am single-handed with a list size of 3,500 patients in a deprived area of inner city London. Even if 2% of my patients want to see me for 10 minutes it would be almost 12 hours without any breaks. How can one cope and one survive in this silly situation? The options are to retire or die of a heart attack!’

Taking work home

More than 50% of GP partners hold more than 40 consultations each day, and one third take work home with them twice a week or more, our survey found. More than 15% say they take work home every night.

One Northern Ireland GP said: ‘The other day I got home at 9.30pm and my head was beginning to spin after 13 hours of continuous work. Why, in heaven’s name, does this nation expect doctors to work day and night without rest and castigate them for seeking appropriate rest?’

A huge 83.4% of GP partners told us their work has become more stressful over the last year.

Thirty-five GP partners who completed the survey said they have sought psychological help for work-related stress in the past year.

The workload for salaried and locum GPs is more varied. Although 13.5% say they work 12 hours or more a day, 24.8% work less than a seven-hour day.

They tend to see fewer patients that GP partners, with 63.9% of salaried and locum GPs holding between 20 and 40 consultations each day, and 28.2% treating more than 40 patients.

There is a significant difference in the amount of work that salaried and locum GPs take home, compared with their partner colleagues.

More than a third of salaried and locum GPs say they never take work home with them, compared with 15.8% of GP partners. While more than 15% of GP partners take work home every night, less than half that proportion (7.3%) of salaried and locum GPs take work home every day.

A Sheffield GP who regularly takes work home said: ‘I spent a lot of time out of surgery hours doing the quality and productivity work for QOF last year. Any work such as patient participation group work, practice changes, creating protocols and templates etc, cannot be completed within my core hours.’

‘Spiralling’ demand

GPC deputy chairman Dr Richard Vautrey said GPs are struggling with ‘spiralling’ demand from an ageing condition with increasingly complex conditions.

‘The findings of GP’s survey are sadly consistent with the feedback the BMA has received from grassroots GPs in the past year, including in our own surveys,’ he said.

‘GPs are working harder than ever before to cope with this workload, including undertaking an estimated 340 million consultation a year, a figure that is rising annually. However, rather than working with the profession to meet these challenges, the government has imposed a series of changes to the GP contract that has reduced average practice funding and introduced more administrative box-ticking that is diverting valuable time away from treating patients. This has added to the unprecedented stress facing GP practices and it is not surprising that GPs are suffering from burnout.

‘We need to urgently address the challenges facing general practice, not least as ministers appear to want more work to be undertaken in primary care without a commitment to provide additional resources.’

Help available

Support services for stressed GPs are available, provided mainly by deaneries and the BMA.

Deaneries run professional support units (PSUs) - some of which are available to doctors throughout their career - and they provide a varied mix of help with career development and wellbeing support.

The PSU run by the London deanery, for instance, offers psychological assessments and support; coaching and mentoring; courses for GPs on management, record-keeping and communication; and careers support, including occupational psychology.

The BMA provides a 24-hours-a-day, seven-days-a-week counselling service, and a doctors for doctors service offering medical advice. Its website includes a ‘burnout test’ to assess the effect of long and gruelling working days, and it has just completed a one-year pilot providing emotional support for doctors facing GMC fitness to practise cases.

‘Challenging time’

A spokesperson for NHS England said it recognises that this is a ‘challenging time’ for GPs.

‘We do not want to increase the workload of GPs, but rather encourage GPs to work differently to meet patient needs. We want to encourage GPs to re-prioritise workloads, for example reducing bureaucratic tick-box exercises and, instead, re-direct this work into actions that will directly benefit patients.

‘GPs are responsible for managing workload in practices and a number of practices have already put in place appropriate mechanisms to work as productively as possible – such as clinical triage, opportunities for patients to have e-mail or telephone consultations and same-day walk-in services.’

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