GP W ellbeing Combatting Burnout in General Practice GP W ellbeing Combatting Burnout in General Practice Adam Staten Euan Lawson CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2018 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Printed on acid-free paper International Standard Book Number-13: 978-1-1380-6634-2 (Hardback) 978-1-1380-6627-4 (Paperback) This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to publish reliable data and information, but the author and publisher can- not assume responsibility for the validity of all materials or the consequences of their use. 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Identifiers: LCCN 2017034018 (print) | LCCN 2017034987 (ebook) | ISBN 9781315159218 (Master eBook) | ISBN 9781138066342 (hardback : alk. paper) | ISBN 9781138066274 (paperback : alk. paper) Subjects: | MESH: General Practitioners | Burnout, Professional--prevention & control | Adaptation, Psychological | Job Satisfaction | General Practice | United Kingdom Classification: LCC R118 (ebook) | LCC R118 (print) | NLM WB 110 | DDC 610--dc23 LC record available at https://lccn.loc.gov/2017034018 Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Contents Preface ix Dr. Adam Staten and Dr. Euan Lawson Introduction xi Dr. Clare Gerada 1 What is burnout? 1 Dr. Adam Staten Key features of burnout 1 Impact on the individual 3 Effect on the GP workforce 4 Effect on the wider NHS 7 Conclusion 8 References 9 2 External pressures 11 Dr. Adam Staten The Quality Outcomes Framework 12 The Care Quality Commission 12 Political mandate and continual structural reform 13 A negative media portrayal 14 A more litigious society 14 Conclusion 15 References 16 3 Pressures of the job 19 Dr. Adam Staten Increasing workload 19 A population increasing in age and morbidity 20 Squeezed budgets 22 Time pressures 22 Increasing dependence of patients on doctors 23 Rising patient expectations 24 Poor coordination between primary and secondary care 24 v vi Contents Conclusion 25 References 26 4 Changing the system 29 Dr. Adam Staten Corporate power of GPs 30 Value of the CCGs 31 GP federations 33 Harnessing social media 34 Conclusion 36 References 36 5 Changing the way we work 39 Dr. Adam Staten Embracing technology 39 Interacting with the practice computer system 39 Communicating via new technologies 41 Telehealth 42 Increasing the skill mix in primary care 43 Physiotherapists 43 Pharmacist and medicines management 43 Physician associates 44 Mental health workers 45 Innovative models of seeing patients 45 Telephone triage 46 The Roundhouse Model 46 Shared medical appointments 47 The virtual ward and coordination of care 48 Conclusion 48 References 49 6 Finding the right career 53 Introduction 53 GP partner 54 Dr. Adam Staten and Dr. Peter Aird What makes being a partner different? 54 Other aspects of the job 54 How to become a partner 54 The remote and rural GP 58 Dr. Kate Dawson What makes rural general practice different? 58 Other aspects of the job 59 Career options in rural general practice 59 Community hospitals 60 The rural fellowship 61 Conclusions 62 Contents vii The overseas GP 64 Dr. Tim Senior What makes overseas general practice different? 64 Other aspects of the job 65 Career options in overseas general practice 65 How to become an overseas GP 66 Conclusions 68 The military GP 69 Dr. Adam Staten What makes military general practice different? 69 Other aspects of the job 70 Career options in the military 70 How to become a military GP 71 Conclusions 73 The entrepreneurial GP 74 Dr. Knut Schroeder What makes entrepreneurial general practice different? 74 Other aspects of the job 75 Career options in entrepreneurial general practice 75 How to become an entrepreneurial GP 76 Conclusions 78 Useful further reading, links and resources 78 The humanitarian GP 79 Dr. Rebecca Farrington What makes humanitarian general practice different? 79 Other aspects of the job 80 Career options in humanitarian general practice 81 How to become a humanitarian GP 82 Conclusions 84 The academic GP 85 Professor Alistair Hay What makes academic general practice different? 85 Other aspects of the job 86 Career options in academic general practice 87 How to become an academic GP 87 Conclusions 89 The educational GP 91 Dr. Euan Lawson What makes medical education different? 91 Other aspects of the job 92 Career options in medical education 92 How to get involved in medical education 92 Undergraduates opportunities 92 Postgraduate opportunities 93 viii Contents Learners in practice 93 Working as an appraiser 93 How to become an educational GP 94 Conclusions 95 Resource 96 References 96 7 Resilience 97 Dr. Euan Lawson Neurobiology of resilience 98 Acute stress response 98 Physician personality and resilience 98 Other features associated with resilience 100 ‘Realistic’ optimism 100 Facing fear: An adaptive response 100 Ethics and altruism: Having a moral compass 100 Religion and spirituality 101 Social support 101 Having good role models 102 Being physically fit 102 Brain fitness: Making sure your brain is challenged 102 Having cognitive and emotional flexibility 103 Having ‘meaning, purpose and growth’ in life 103 The paradox 103 GP wellbeing: Lessons learned from a trainee-led initiative 105 Dr. Duncan Shrewsbury References 106 8 Interventions for burnout 109 Dr. Adam Staten Personal coping strategies 109 Organisational interventions 110 Reactive interventions for the individual 111 Proactive interventions for the individual 112 Mindfulness 114 Conclusions 115 References 115 9 Final thoughts 117 Dr. Adam Staten and Dr. Euan Lawson The paradox of modern medical practice 117 Burnout and stigma 117 The science of happiness 118 Coming changes 119 Reference 119 Index 121 Preface INTRODUCTION The phenomenon of doctors becoming overwhelmed by the stresses of their job is not new, but in recent years burnout has become an enormous issue in UK g eneral practice. The many accumulated stresses of life as a general practitioner (GP) are taking their toll and are causing nothing short of a workforce crisis. A survey of more than 2000 National Health Service (NHS) GPs conducted by the journal Pulse in 2015 found that 50% of them thought that they were at high risk of burnout. This figure had risen from 46% just 2 years previously. A Commonwealth Fund survey conducted in the same year found that 29% of UK GPs wanted to leave the profession within 5 years, and yet more were unsure whether their long-term future lay in general practice. At a time when the NHS needs more GPs than ever, it is instead haemorrhaging doctors at an ever- increasing rate. The workload of general practice seems to be increasing inexorably, report- edly increasing by 16% in the past 7 years. In 2013, GPs provided more than 340  million patient consultations, a rise of 40 million from 2008, and this accounted for 90% of patient contacts within the NHS. The Conservative govern- ment elected in 2015 made a commitment to provide 5000 more GPs by 2020 to help relieve the pressure, but with falling recruitment, early retirement and many doctors simply walking away from clinical practice in the middle of their careers, this looks like an unachievable aim. Worryingly, half of GP leavers are younger than 50 years old and 77% of those planning on switching career are younger than 55 years old. It seems that GPs are burning out quickly and burning out young. CAN IT REALLY BE THAT BAD? General practice remains the last bastion of medical generalism in a world of increasing specialisation. Unlike our secondary care colleagues who work in ever- narrowing fields, general practice is a cornucopia of physical and mental pathology, and one of the few places in medicine where doctors come at symptomatology and disease fresh while it is untainted by the investigations and treatments of others. It is only in general practice that care can be truly holistic and where we have the ix