Three quarters of GPs face 'mental distress' after working through pandemic, BMA warns

Three quarters of GPs are facing 'mental distress' because factors such as heavy workload and understaffing have left them unable to provide the support they want for patients, a BMA report reveals.

BMA House (Photo: Malcolm Case-Green)

Almost half of GPs, meanwhile,  have been left with more severe 'moral injury' - a term defined as arising where 'sustained moral distress leads to impaired function or longer-term psychological harm'.

BMA polling of more than 2,000 doctors found that close to four in five felt that moral distress described their experience at work, while just over half felt they had experienced moral injury.

The BMA report highlights a 'significant equalities impact' - with doctors from minority ethnic backgrounds, female doctors and older doctors more likely to report experiences that fit with the definition of moral distress or injury.

GP crisis

The findings come a week after a damning report from MPs warned that NHS workforce planning needs a total overhaul to address rising levels of burnout in the medical profession and the wider NHS workforce.

GPonline reported last month that there are 10% fewer full-time equivalent GPs per patient now than just five years ago - while analysis of RCGP data shows that levels of workload have soared.

Findings from the BMA poll show that the rising toll of moral distress in the NHS workforce threatens to deepen the workload and workforce crisis facing the health service. Nearly half of doctors who responded said they would consider early retirement, while two thirds said they would consider reducing their working hours.

One GP who took part in BMA polling said: 'I’m very aware that under normal circumstances I could’ve done a lot better, I’m frustrated that the personalised care that I value so much has been wiped out in a sea of demand and different ways of working and I just want all this to end and go back to normal, but I do not see that coming, at least not in the working life that I have left.

Sheer exhaustion

'In January this year I had a particular low point and just wanted to leave to escape the unpleasantness, sheer exhaustion and the long winter.'

The BMA has set out recommendations to tackle the problem - demanding actions at an NHS level including improved funding and resourcing for services, better staffing, recognition of clinical autonomy and the promotion of an open and sharing culture in the workplace.

It has called for more support such as counselling to be made available to health professionals and for work to reduce bureaucracy.

Doctors can also take steps themselves to reduce the impact of moral distress, the BMA says - for example through talking to each other about the problem, developing support groups, speaking out where necessary and through seeking advice when they face tough ethical decisions.

BMA consultants committee deputy chair Dr Helen Fidler said: 'The results of this research are, without doubt, incredibly worrying. However, what is important is being able to now name the struggles that many doctors are facing is the first step in helping to tackle these issues and pinpoint exactly what needs to be done to alleviate them. As doctors, we need to be the doctors we want to be, rather than the doctors we have to be.

'As with many pre-existing pressures on staff in the NHS, the COVID-19 pandemic has only exacerbated moral distress and moral injury. Doctors have less autonomy, government support has failed to keep up with patient demand, and we’re now at the point where these pressures are driving talented professionals to breaking point, with many staff even leaving the health service because of it.'

How the BMA defines moral distress and moral injury:

  • Moral distress refers to the psychological unease generated where professionals identify an ethically correct action to take but are constrained in their ability to take that action. Even without an understanding of the morally correct action, moral distress can arise from the sense of a moral transgression. More simply, it is the feeling of unease stemming from situations where institutionally required behaviour does not align with moral principles. This can be as a result of a lack of power or agency, or structural limitations, such as insufficient staff, resources, training or time. The individual suffering from moral distress need not be the one who has acted or failed to act; moral distress can be caused by witnessing moral transgressions by others.
  • Moral injury can arise where sustained moral distress leads to impaired function or longer-term psychological harm. Moral injury can produce profound guilt and shame, and in some cases also a sense of betrayal, anger and profound ‘moral disorientation’. It has also been linked to severe mental health issues.

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