Table Of ContentGP W
ellbeing
Combatting Burnout in
General Practice
GP W
ellbeing
Combatting Burnout in
General Practice
Adam Staten
Euan Lawson
CRC Press
Taylor & Francis Group
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Library of Congress Cataloging‑in‑Publication Data
Names: Staten, Adam, author. | Lawson, Euan, author.
Title: GP wellbeing : combatting burnout in general practice / Adam Staten,
Euan Lawson.
Description: Boca Raton : CRC Press, [2018] | Includes bibliographical
references and index.
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
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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
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