Not sure how much longer I can keep working like this (NHS GP)

[TiredofbeingaGP]

I've name changed for this, as don't want it tied to my usual username.
Sorry this is long, I guess I just want to vent and consider my options, and I'd be interested to hear from anyone who's been in this situation and come out of the other side of it...

I'm a GP in a severely understaffed practice. It's a medium sized practice that's run by a non-profit group that has taken over the contracts for several practices in the area, as the partners have handed back the contracts to NHS England for various reasons (retirement, emigration, burnout).

I've been there for 2 years (qualified GP for 11 years), and there's never been much stability of clinical staff, but the management are supportive, if overstretched themselves. There's lots of good innovative thinking, but this translates into an exhausting rate of change. At the moment this is causing low morale in the admin team and some of the clinical team.

I'm an introvert and a HSP. I have a lovely, energetic and exhausting 8yr old DS, and a lovely but busy DH, who is a full time consultant in a hospital specialty, so works a lot of weekends and evenings.

I have always struggled with the emotional burden of general practice - I'm the sort of GP who listens, and is supportive and understanding, and therefore runs late all the time (my regular patients bring a book). I wouldn't/ couldn't practice any other way, and I do make a difference to my patients' lives, but it means I shoulder more than my fair share of complex chronic illness and mental health issues (especially when we need a lot of locum GPs to keep afloat).

I am increasingly struggling with stress and anxiety. This has been worse since Easter, when another GP left, and I've been on-call constantly since then. I only work clinically two days a week, but those are inevitably 12 hour days, busy and full of clinical risk, trying to sort out the same day urgent work and fit in my regular patients as well. I then do the vast majority of parenting and the mental load of the household, simply because DH isn't around much. When he is here, he mucks in and does his share of parenting and housework.

I gave up a stressful academic post last year, having had to take time off sick with stress the year before. Initially this helped a lot, but since then we've lost two more GPs.

I am doing all the self care stuff - talking to colleagues, exercising regularly, trying to eat well, meditating, CBT-ing myself constantly, taking time on my own when I can to recharge - but increasingly it isn't enough to keep my head above water. I'm not sleeping well, feeling tearful a lot of the time, binge eating carbs (which is a stress response), having difficulty letting go of work when I'm at home, being grumpy and impatient with DS and then feeling really guilty.

I'm aware the practice isn't really safe - I keep picking up on things the locums have missed, some because they aren't very good, and some because they just don't know the patients. Continuity of care saves lives. I'm also aware that my decision making after 11 hours of clinical work isn't the best, and I worry about what I'm missing.

The thing is, I don't think the grass is necessarily greener elsewhere (IE working for a different practice), and I don't know what else to do to keep going. I've tried academia/ medical teaching (massive workload, bullying management), tried working part-time, tried walk-in centre work (missed the continuity and the contact with other GPs).

I've talked to the managers and they know I'm struggling, but there's little else they can do unless we can recruit more GPs, and they're very thin on the ground! I don't really want to take medication for symptoms that are actually a fairly proportionate response to an impossible situation. I also had a severe adverse reaction to sertraline, so I'm wary of taking anything similar. I love being a GP, but not at the indefinite expense of my mental health and my family.

Any ideas how I can get out of this mess?!!

Hi, I've worked many years in the NHS and can sympathise wholeheartedly. One of the first things that sprang out in your post was 'what a fantastic GP you sound, I wish you were mine!' and the second thing, do you off load any of the stuff like housework as this is obviously a big chunk of work too, esp with a DC?

I'm really sorry to hear the stress you are under, I could no longer cope with full time nursing when I had 2 young DC, shifts too long, too understaffed etc. Wish I had some answers for you!

If you have spoken to management are they aware that they could potentially lose a very good knowledgeable GP, do they really want that? In other words, have you any negotiation power for recruiting more staff or reducing some of your hours?

Could you consider going private? I don't work OK healthcare but private practices always seem much better run and quieter than the NHS ones.

I wanted to start by thanking you for what you do. I don’t think people understand the stress that general practice is under and I can’t see it getting better in the immediate future. I left medical school in my final year so have some understanding of what you describe. I’m now a mental health nurse. I always tell my patients that I can’t look after them if I don’t look after myself- the same applies to you although I acknowledge that you are doing a lot to manage your mental health already
You sound stressed and don’t take this the wrong way- it sounds like you are experiencing burnout.
Like I said I honestly don’t think things are going to improve anytime soon and potentially will get worse. Do you want to be part of this as you seem to be paying the price with your health
Can you talk to one of the dr counselling services? Is there a supervisor you respect that will let you talk things through I.e. someone not attached to the practice?
Sleep- sleep hygiene and a short course of zopiclone??
You also show signs of depression- can you see your gp? I can recommend a psychiatrist who specialises in medics and dentists so message me if you want details- she’s very very good
Antidepressants- lots of options. Mirtazapine could help with sleep. Venlafaxine very good
Sorry if I’m teaching you to suck eggs
I think though you know the answer deep down- is it worth it?
Btw how nice to have a gp who cares. Your patients must really value you

My friend is an amazing GP and mother to 4DC, her last two are twins. She works 5 days a week now but will only do double or triple appointments. She works 8 hours a day with an hour for lunch. She sleeps for 30-45mins on her examination during her lunch as her twins are toddlers who wake up during the night.

Would something like this work for you 2-3 days a week? Also, you can't CBT yourself. You need to see a professional therapist who can do CBT with you.

You sound wonderful.

Are you off work 3 days a week? If your DS is at school, do you get time to relax and de-stress? Have you got a cleaner and perhaps someone to iron as well? Would that help?

Could you get an au pair/ nanny/ some extra help with housework, home admin and childcare to buy yourself more down time? I'm so sorry you, and other GPs are in this position.

I'm really sorry i can't offer much advice but i wanted to say a massive thank you for what you do. Without GPs like you - willing to listen & actually caring about outcomes rather than worrying about time constraints - neither me nor my DP would be here today. I don't think people give their GPs enough recognition or thanks, so thank you so much

Sounds like part of the problem is that the job just isn't doable on a 2 days per week basis. This is why the 2 days are so long and arduous.

Sometimes trying to make professional jobs work part time is not as beneficial as it sounds. I worked part time when my kids were younger but the nature of the job meant that my caseload of clients was just as long as the full timers and because I was more experienced I was allocated all the difficult clients. After a while I realised I was working full time but compressing it into 3 days and only being paid for those days.

Would it be possible to split your time across more days but with a shorter working day? Or would a formal job- share arrangement work with a likeminded GP so you could do 2.5 days each with significant handover period so you felt confident your patients needs were being dealt with when you were off?

You need to give up the on-call. My friend who is a mother to 5, under 13years, has given up on call & looks like a different woman and her quality of life has greatly improved.

You also need to get help at home.

Finally, if this isn’t possible how long can you stop before you loose your registration? No job is worth loosing yourself over, so can you stop for a while and pick up some locum work when you feel better?

Thanks Shady, that's very kind of you!

DH isn't keen on having a cleaner - we both have very working class roots, but he grew up with a lot of financial stress and he doesn't like hiring people to do jobs that we're perfectly capable of ourselves. I do most of the cleaning, and all of the laundry, He hoovers/washes floors and does most of the cooking and meal planning/ online grocery shopping. He was off work this week and (after I had a bit of a meltdown at the weekend) he and DS cleaned the house from top to bottom, but I agree that we need to revisit the idea of a cleaner, and it would help if the house was consistently clean without me having to make it happen.
I find the mental load of remembering everything for school for DS, ensuring child and dog care is sorted, keeping track of paperwork etc wearing. I've minimised this as much as possible, all bills are on direct debit etc, but it needs doing and I don't think it could easily be outsourced.

Management are actively trying to recruit GPs, it's just that there aren't many around that want to work as salaried docs at the moment. Most want to locum (twice the money, half the stress!), or go abroad soon after completing training. We're fully staffed with nurse practitioners and other clinical staff, which is great, but it means that everything that can possibly be dealt with by someone else, is being, which leaves complex medical issues and mental health problems for me to see, with no simpler appointments in between to catch up a bit. I have negotiated 15 minute appointments when not on call, but I've been on call every time I've been in the practice for the past 3 months, so not really seeing the benefit.

I'm only working 2 days a week. I'm contracted for a 10 hour day, but I won't leave until I'm sure things are safe to leave overnight, which means checking all the blood results etc, and often I'm still phoning patients from the on call list at 8pm, long after the rest of the staff have gone home.

DH has said I can resign if I need to, but I don't want to if I can possibly avoid it.

I’m a social worker but can empathise with the low staffing, lack of continuity with locums, high risk work.
You can’t fix the problems single handedly.

A good friend of mine told me that after burning out years ago she now does the work she is employed to do and hands anything that does not fit in her working day back. I tried it, it does actually work.

It’s really hard to do but to protect yourself and ensure you are working safely it does work. You have to say ‘no’.

No I cannot ; pick up that extra case, call, visit as I have all these on my list. Manager if you think this new case must be seen, what will you take out of my workload to enable me to do that?

Do that or burn out. The choice is stark I know.

Or, I have just moved to the most amazing GP practice where there are never more than 2 people is the waiting room and always none urgent appointments available same week. They, like everyone else are recruiting if you fancy a southwest role?

Do you work the 2 days together? So say Monday and Tuesday? And then you switch off for the rest off the week? I'm trying to understand why you are not getting time to relax when your DS is at school? Do you think you could be depressed? Would it help if you spread your 2 day hours across 3 days?

Are you a BMA member? They can give you emotional and practical support.

Get a cleaner. DH also has cleaner "issues"
I just got one and paid for it myself. He didn't even notice the house and was cleaner!!

Get a cleaner or tell DH he's doing it. They are his principles so why should you suffer for them??

So the person who doesn’t do much of the cleaning doesn’t think you should get a cleaner? That happened in my house and I said Well sod that. There are many things I could do myself that I pay someone else to do. You have two busy careers and presumably could afford it so crack on and get one. Many people find having a cleaner awkward at first. But now we pay someone to clean and do laundry and it makes a big difference. Free time can be spent much more free if not trying to find in mopping and getting a wash on.

If you at your cleaner a decent rate and treat them well that generally dispenses with working class angst.

I took so long writing that that I crossposted with lots of people!

Thank you for your kind words. It does help. I have some lovely patients who value what I do for them, but I also get a lot of disgruntled people who are unhappy with waiting times for appointments/ the difficulty getting to see a GP/ lack of regular GPs. I seem to spend a lot of time apologising for things that are beyond my control.

I believe strongly in the NHS and healthcare for all who need it, so thank you for the suggestion, but I'm not really interested in working privately.

I can't drop the on call as there's literally no-one else to do it, so I'd end up dealing with all the on call stuff on top of a normal clinic day, which would be even less safe. This is what has happened when we've tried to have locums do the on call to give me a break.

I do get some downtime when DS is at school on my non-working days, and he does an after school club on one of those days, so I get a bit longer. I go to the gym for a couple of hours twice a week, and try to fit in a daily meditation. Beyond that, my time just seems to get eaten with chores, and I struggle to motivate myself. I used to write and sketch, but I haven't managed much of that for years!

I don't think I'm burned out - I do still care, although I get a bit weighed down by all the suffering. But I'm very stressed. I have seen a psychiatrist who specialised in Drs previously, due to family problems a few years ago (around the same time as the sertraline debacle), and I'm not as unwell now as I was then, but I don't want to get to that point again. I am a bit depressed I think, but it's situational.

GPs have to do a minimum of 20 days a year of clinical work in order to maintain their license to practice, so I could take a break of several months if I needed to. I would feel very guilty about it, both for leaving my patients and colleagues to struggle, and because DH finds being the only breadwinner very stressful (if my maternity leave is anything to go by!).

I don't really get the cleaner angst. My cleaner runs a successful cleaning business that's employs her, her DH and several family members. They have plenty of clients and seem to be doing very nicely for themselves.

I know so many GPs who feel like you do.
The ones who cope are the ones who have lots of domestic help.
Definitely get a cleaner. That, IMO, is a no- brainer.
If you can find someone who will do 2 shifts and take on the laundry and ironing that is even better. Yes, you will pay for it, but it is so important to keep your registration.
Consider finding an au pair, or an overseas student who would be willing to make packed lunches etc.
My friend is a social worker in a very tough area. Her husband left her and their 2 small dc. She had a series of au pairs and that saved her career, her dc and her sanity.
I wish my GP was as helpful as you. Mine told me not to come and see him after my son died because he wouldn't have time to talk to me. I despair of the way things are going.

Agree with others - get a cleaner as a start point. If dh is anti, position it as a trial - if it doesn't work, you'll stop. You bloody won't. I went years avoiding a cleaner out of guilt/a feeling this was stuff I could manage if I just got on with it. I honestly would give up booze now before giving up my cleaner!

And think radically about what else you can outsource and/or where you can make a commitment to your own MH. Could ironing be outsourced? Try it. Could you outsource meal planning once a week (get a really good takeaway or Cook type optio) - do it. Do you have a weekly yoga class that you could commit to? Do it. Could you commit to one day a month when you have a night away in a local spa? Swim; lovely supper; early night; breakfast sorted in the morning.

Some of these may become untenable long term, but you sound like you're burnt out and everything you are doing to train and look after yourself isn't really hitting the edges. Time to bring in the big guns.

And as others have said, thank you. A good NHS GP is gold dust, and we want you to find a way to stay!

You (well, your DH) absolutely have to get over the cleaner issue, that's just crazy. I do appreciate the sentiment but it's massively misguided and actually a bit judgemental. There is a strong argument to say that households with good incomes have a moral obligation to use some of their wealth to provide much needed (non-exploitative) employment to other people.

But you're not perfectly capable of doing the housework?! You don't have the headspace or time. You'd be giving someone a job and you don't need to treat them like a slave...my friends cleaners are all paid reasonably well and are very much appreciated.

You sound like a wonderful GP. Just how they should be...:)

Oh op I haven't read the whole thread but please rethink what you are both doing.

Get someone in to clean the house, do your ironing, maybe even prep your evening meals for you.

Also can you do your hours over 3 days rather than 2 or look at some other kind of working pattern?

I can see how easy it is for your dh to say he doesn't want a cleaner but your health is at risk and realistically you both earn good salaries. What's the point of doing any of it if you are not well enough to enjoy life? You are clearly taking the brunt here.

It's easy to be idealistic when it's not you carrying the burden.

I have a cleaner 3 hours a week. Modern 3 bed house. She does all my cleaning and ironing (me & ds5).

Why would you give up a career you clearly love and worked hard for (my gp was like you - she was brilliant) and you make such a difference to so many lives.

My friend has a "housekeeper" who comes in every day & does washing, ironing, cleaning, tidied up & preps dinner a couple of days. Df has time to go out at the weekends to watch dc's play football, cricket etc.

Do what you need to do. Please don't try to keep doing what you're doing. At some point you will not be able to keep going and then your dc and you may suffer which is no good to anyone least of all you take care xx

Surely getting a cleaner is better than you quitting your job! Be blunt with your husband, that's the choice you are heading towards.

You really are working 4 days a week into two, and the stress of the job is immense. I have friends who are GPs and even though they love it, and it was their dream career, the reality and the long days have eaten away at them. One of the toughest I know nearly had a breakdown a year or two back.

Thinking outside the box- could you chat again to the partners and find out if there are any options- would three days but 8 hr shifts be better? Or even really thinking outside the box- what about moving to another country which has regular hours for GPs? A sabbatical?

It's clear you can't continue as you are, I also wonder if you are affected by the bullying/research post issue into this year, something like this can really knock you.

I can't offer any advice, but thankyou for doing what you do: your value to the NHS and to the country is immeasurable

One possible suggestion: if you are unable to recruit any more GPs, would it be possible to recruit one of the new Physician Associates to reduce some of the workload?