The death of Surrey GP Dr Gail Milligan earlier this year rocked the profession. Dr Milligan, a dedicated, much-loved and highly-respected GP partner, took her own life at the end of July after the pressure of her job became overwhelming. She was 47.
Her death prompted the BMA and RCGP to call on the government to do more to protect doctors from spiralling workloads and to take steps to address the unmanageable demands placed on general practice.
Following her death, Dr Milligan’s husband Chris wrote a heart-breaking and moving tribute to his wife that was widely shared on social media. Mr Milligan is now speaking to GPonline because he wants people to understand how hard GPs like his wife are working and the impact it is having on their wellbeing – and also in the hope it could prevent other doctors from taking their own lives.
He says that the ‘most important thing’ is that lessons are learned from what happened to Gail.
‘I would really want public opinion to start changing,’ Mr Milligan says. ‘I understand people being frustrated because they can’t get a doctor’s appointment but they need to know the real story of what’s going on behind the scenes and how hard these people are working – that doctors are dying to offer services that they know aren't up to scratch any more.
‘I don’t want anyone else to have to go through this – it is awful.’
'Gail always went above and beyond'
Mr Milligan met Gail 30 years ago, when she was 18 and had just completed her A-levels. They married eight years later in 2000 and went on to have two sons. Mr Milligan says his wife wanted to be a GP from the age of six and that she excelled academically as she pursued her ambition.
‘She was always someone who put high expectations on herself,’ Mr Milligan says. ’Her university friends have said that Gail was always the one who went above and beyond with her work at medical school. If there was anybody that needed help, her door was always open and she would help them with their work - and other struggles as well – she was always there for them.’
Dr Milligan qualified from medical school in 1998 and trained as a GP in Reading. She went on to become a partner at Camberley Health Centre in Surrey in 2003 and was still working there when she died this year. Alongside her work as a partner she was also a GP trainer and involved with work for the local CCG.
Mr Milligan explains that work had become increasingly demanding in the years leading up to the pandemic, but it was at the start of the pandemic when his wife was set up to work from home that her workload spiralled out of control.
‘When they sent over laptops and gave them full access to the systems from home she lost her sanctuary,’ he says. ‘She said to her partners in previous years that she could switch off from work when she got home – and she lost that.
‘She could not step away from work. And then it just took over more and more of her time, to the point where she had no time to do anything else because her mind was constantly on work. And she felt guilty for stepping away.
‘It really started to affect our home life and it became normal really quickly. She became a shadowy figure in our lives. She was at work for 12 to 14 hours, and when she got home she was working.
‘Even when she had switched off her laptop and was watching something on the TV, she would have her phone and was fielding work-related emails. The only time she switched off was when she went to sleep and I know that her sleep became very disturbed.’
'Work became neverending'
Mr Milligan says his wife was working 70 to 80 hours a week, sometimes more, by the time she died.
Dr Milligan was an eight-session partner with a day off on Thursday. However it became normal for her to work for 12 hours at home every Thursday, refusing to even leave the house for the regular dog walk the couple used to take, alongside the 12- to 14-hour days she was at the surgery during the rest of the week.
‘It was never ending – she had no free time at all. And it gradually began to creep into the weekends as well,’ Mr Milligan says.
‘She would easily work from seven until seven on a Saturday and the same again on a Sunday. They are extreme examples, but every weekend she was working at least six or seven hours each day.’
Mr Milligan says his wife’s partners didn’t realise how many hours she was putting in. ‘They just put it down to Gail being phenomenal and being excellent at her job.’ Meanwhile, he thought the other partners in the practice were working similarly excessive hours because of the pandemic.
‘It was a time of crisis, and I was hoping that after the pandemic things would calm down and return to a bit more like they were before - which was still ridiculous but not that bad,’ he says. ‘I didn’t realise that once the genie was out of the bottle it was too late and that working from home would become a thing and I don’t think they will ever get rid of it again.’
Mr Milligan tried to convince his wife to resign her partnership or cut back her hours on several occasions. ‘But it was about her drive to care. That’s the thing that really sucked her in and she couldn’t walk away from it,’ he says.
Throughout her career – and in her personal life – Dr Milligan had helped many people deal with their own mental health challenges. Mr Milligan tells how she supported friends suffering from poor mental health during the pandemic. Her brother told those at her funeral how Dr Milligan had helped him through a particularly challenging period in his life.
Meanwhile, she supported a fellow doctor who made the decision to take a year out of medicine because of the pressures of the job. ‘If only she could have taken her own advice,’ Mr Milligan says.
'I was waiting for her to come home, but she never did'
As a partner, one of Dr Milligan’s responsibilities at the practice was HR and it was an incident involving this aspect of her role that Mr Milligan believes was the catalyst that ultimately led to her taking her own life.
Dr Milligan received an email about a HR problem on a Sunday night in July after the couple had returned from a two-week family holiday, and ‘it tipped Gail over the edge,’ her husband says.
He explains for the following week his wife was very stressed. ‘She thought she had failed everybody, she had catastrophised about what was going to happen. She had a week of beating herself up about it, and obsessing over it.’
Mr Milligan says her colleagues ‘tried to explain to Gail that she was wrong, but she wouldn’t listen at all. She had gone beyond that - she thought she was right and they were wrong.’
Dr Milligan went into work on Wednesday 27 July, just over a week after receiving the email, and while there she became quite distressed, Mr Miligan says.
‘Her colleagues sat down with her and spoke to her saying “Gail you’ve got this wrong, you’re thinking is not right, go home and take some time and come back when you are thinking more rationally”.
‘I didn’t realise that she’d left the surgery at 3pm. Normally she didn’t get home until 7.30 or 8.30 and I was waiting for her to come home and she never came home,’ Mr Milligan says.
At about 9pm Mr Milligan became increasingly worried because his wife wasn’t answering her phone. He drove to the surgery thinking she might still be at work, but her car wasn’t there. When he got home he phoned Dr Milligan’s senior partner and discovered his wife had left the practice at 3pm. They decided to call the police.
‘The police came instantly and they were with me until they found her. They found her in a forest setting at about half past 10 the next morning. She’d gone in, she’d hidden herself away.’
'We are broken as a family'
Dr Milligan’s death has had a devastating impact on her family, colleagues and friends. ‘We are broken as a family - and Gail’s friends are as well. Our wider friend network and family network – we’re all broken by this,’ he says. ‘She didn’t have a history of depression and mental illness so everybody was so shocked. It's just pulled the rug out from everybody.
‘I've lost my wife and my best friend. We always spoke about absolutely everything. And this is what really hurts, the fact that she couldn't reach out. Or maybe she didn't know just quite how bad she was until it all came collapsing down. We will never know.’
Mr Milligan says that in the months leading up to her death Dr Milligan ‘struggled a lot’ with the negative media coverage of general practice and claims that GPs were ‘lazy’ and not seeing patients face to face. She also experienced increased levels of abuse from patients, including ‘people screaming at her’.
His wife found it difficult working in a system where she wasn’t able to provide the level of service that she wanted, he explains.
‘GPs have to break their backs to deliver a service that they know isn’t good enough, which is all part of the pressure,’ Mr Milligan says. ‘She knew she couldn't deliver the service she wanted. She knew that they would have to let people down because there just weren’t enough hours in the day.
‘People were saying GPs were lazy and she was working herself to death.’
Mr Milligan believes there are lessons to be learned from his wife’s death. He would like to see workload limits introduced for doctors, as well as protected time to allow them to ‘decompress’ if they are involved in difficult cases or situations. He also says there should be proactive intervention to identify and then support GPs who may be struggling because Dr Milligan would never have put herself forward for help.
He says he no longer thinks general practice is a safe place to work, particularly for partners. ‘The extra pressure from being a partner is relentless. I think it is a very dangerous profession to be involved in because you care so much. That’s the problem for someone who cares - they’re their own worst enemy because they can’t switch it off.’
In the period leading up to her death, Dr Milligan ‘kind of wasn’t there for us as a family because she was just giving everything she had to her patients,’ her husband says. ‘She lost herself to the job completely, she forgot who she was.
‘She was give, give, give and she literally kept nothing left for herself. And when it all came crashing down, there was nothing left for her.’
Because of this, Mr Milligan insisted that his wife was spoken about as a person and not a doctor at her funeral. ‘It was hardly mentioned about her being a GP and we did that on purpose,’ he says. ‘We had a dress down funeral because we didn’t want anybody looking like they had come from work. We were wearing Hawaiian shirts. Because it was work that killed her and we didn’t want it to be like a work event.’
When asked if there’s anything he would like people reading this to consider, Mr Milligan says: ‘I don’t want this to happen to another family. That’s the main thing. I just want people not to push themselves so hard. I know they have to keep things working, but I would really want people to be kind to themselves and kind to each other. And not to work so bloody hard. And don’t take on too many responsibilities – because that’s when it can become too much and they lose themselves.’
- Full details on all the support and resources available to doctors experiencing mental ill health are here
- Mr Milligan would like to highlight Doctors In Distress, a charity dedicated to reducing suicide rates in healthcare professionals. You can donate to the charity here.