There’s no doubt GPs are under pressure from increasing workloads, patient demands and expectations – and this high-stress work environment can take a toll on doctors’ mental and physical health.
A recent Royal Medical Benevolent Fund (RMBF) survey of more than 1,000 doctors and charity supporters found that 82% of doctors know of other doctors experiencing mental health issues such as depression and anxiety.
The unfortunate reality is that doctors who are unwell or struggling to cope may be more susceptible to errors and complaints, because they may not be able to practise at their usual level. This could bring them to the attention of the GMC, adding to the doctor’s level of stress.
That’s why it is so important for GPs and GP registrars to look after themselves – for the sake of their own health, their patients’ and also to prevent medico-legal issues.
The MDU surveyed doctors involved in a GMC complaint or negligence claim over the last five years for their views on how they found the experience.
Some 45% (62) of respondents said it was either horrible and the worst experience of their lives, or very bad and disruptive. A further 27% (37) of respondents have either considered leaving the profession or have actually stopped working as a doctor and 10% (14) suffered health problems following the complaint or claim.
GMC and doctors with health problems
In the MDU’s experience, the GMC is sympathetic towards doctors with health problems provided they co-operate with health assessments and show insight.
The GMC's own indicative sanctions guidance states 'erasure is not available in cases where the only issue relates to the doctor's health' and the GMC is also reviewing its processes to reduce pressure on doctors who find themselves under investigation.
However, MPTS panels can suspend doctors indefinitely if there is a risk to patients, perhaps because of a lack of insight into the impact their condition may have on their ability to function.
Most commonly, the doctor will be asked to make undertakings or will be able to continue working with conditions (such as regular contact with a GP, or GMC medical supervisor).
But of course no doctor wants to end up the subject of a GMC complaint in the first place, and that’s why it’s so important to seek help when it’s needed.
The RMBF has developed a ‘Vital Signs’ guide to provide doctors with practical advice, support and resources. The guide sets out key stress and pressure points and encourages GPs and GP trainees to get help early if they are experiencing stress or difficulty.
NHS England is also introducing a new health service for GPs, which is due to launch this month. Its aim is to provide additional support for doctors who are suffering mental ill-health such as stress and burnout. It will include general psychiatric assessment and treatment, support for addiction related health problems and psychotherapy one-to-one and group sessions.
And of course your medical defence organisation is there to provide you with advice and guidance. It is important to contact your defence organisation for help if you are referred to the GMC with health concerns, such as burnout. In many cases, we have helped members agree undertakings with the GMC at an early stage which minimises the strain involved and means they are able to carry on working.
Ways you can help yourself
Talk to colleagues if you are worried about your health. They will understand the pressure you’re under and can help you to keep things in perspective. Your colleagues may also be able to spot if the stress you are under is beginning to affect your performance and you should be willing to listen and respond to their concerns.
You have an ethical duty to register with a GP outside your own family (paragraph 30, GMC Good Medical Practice). If you are unwell, it's important to get an objective assessment and not rely on your own assessment of your health or 'corridor consultations' with colleagues.
The GMC's online guide Your Health Matters advises doctors to 'note early warning signs of illness and take them seriously', suggesting that 'feeling low or irritable, or having poor concentration and low energy may be signs of burnout'.
If you know or suspect your judgment or performance could be affected by burnout, you must consult a suitably-qualified colleague (such as your GP, occupational health doctor or psychiatrist) and make any changes to your practice they advise.
Don't be tempted to self-prescribe to alleviate symptoms such as exhaustion or anxiety as this could leave you vulnerable to a GMC complaint. The GMC says cases involving self-prescribing or informal treatment of family and colleagues have increased from 36 in 2010, to 98 in 2012.
In a review of the MDU's own files, some of the most common drugs involved in such allegations were benzodiazepines and opiates, suggesting the doctors involved were addicted or struggling to cope.
Consider getting further emotional support either from family and friends, while respecting patient confidentiality, or via a confidential support service. Examples include the GMC’s confidential helpline, or the BMA’s Doctor Advisor Service.
- Dr Lennard is medico-legal adviser at the MDU
- GPonline's regular Wellbeing for GPs series provides practical advice and general information to help GPs improve their own and their team's wellbeing.
- BMA Counselling and the Doctors Advisor Service is available on 0330 1231245 24-hours a day, seven days a week.
- Download The Vital Signs, the Royal Medical Benevolent Fund's guide for doctors seeking help and advice.