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?!!

A lot of the GPs are going to Australia!

Have you thought about working with a coach to help you work through these issues? I work with quite a few doctors and a lot of what you say sounds v familiar.
It would be quite different to working with a psychiatrist and you could try put a few coaches to find the right fit for you. (If you decide to explore this route, find someone who does it as their main job and not an add on to their nhs job - as a. its a skilled job that needs a body of practice and b. you would benefit from someone with a range of skills/psychological theories and models at their fingertips not just the GROW model.

OP I realise the grass is not always greener but it's very dark where you are and your Mh is in stake. Would you consider working for a private practise ?
When it comes to tiredness, depression, anxiety etc I had it all, kids , overstretched at work , all too much, the only thing that literally saves me is supplements for depression, tireness, immune, brain function etc which I won't tell you what they are cause you know better
Look after yourself

I'm a senior practice nurse. Been in general practice for 12 years now.
I totally understand your feelings, OP.
There's not enough staff anywhere in any sector of the NHS (apart from management up high it seems!) and it's only going to get worse. I honestly don't see the NHS, certainly general practice, being the same in 5 years tbh.
But I believe that's the government's big plan; it's expensive to keep going so run it into the ground, say it's not viable and sell I off to private sectors.
Meanwhile, it's us who keep the wheels turning and the safety and welfare of our patients continues to be our priority and driving force behind our going to work. Because we care. Because we're the people they turn to and trust. It's a huge privilege to do what we do. But sooooo exhausting.
I was also off sick with stress a few years ago.
I don't know any suggestions about how you can entice/recruit any new GPS I'm afraid. But I wish you lots of luck in finding some as you sound like you're a lovely GP, one i would like working along side and it would be a huge loss to general practice if you were to go xx

Your posts have helped me realise why my GP was sooo good with me when I finally gave in and admitted I was struggling

I also worked in Healthcare, I’d moved into management from a senior clinical post to get away from shift work when I had small DC, and had ended up with an impossible job, targets I vehemently disagreed with and a ridiculous workload. I also had a parent in the early stages of dementia, and had to arrange care from a distance & take over their affairs, including closing down a business and selling their house, all whilst managing my own DC and becoming peri-menopausal.

Looking back I spent far too much time insisting that I was fine that i just needed to get through x or that once A was done I would be able to do B. It was all bollocks of course. I was trying to juggle so many things that I wasn’t doing any of them well. My perspective was that everyone needed me and that I was failing them. I needed to work harder, be better, be more organised.... and it would be fine. I’m hearing similar in your posts.

A well meaning colleague told me about a technique for juggling so many things, whereby you imagined all the things you needed to do as balls in the air, and from time to time, put one or two down when it was safe to do so, to concentrate on keeping all the other balls in the air. What a lovely, fluffy solution that wasn’t.

If the root cause of your stress, depression and anxiety is that you are trying to do too much, the solution isn’t to become a better juggler. It is to have fewer balls.

A cleaner can help - and I agree you should use one - but it won’t reduce your professional workload an iota. Be honest, are you going to spend the time you get back on you or your work?

Admitting that you can’t cope with an impossible workload - and one that you don’t expect locums to do - isn’t failing. It’s being honest and realistic. Truthfully, could anyone else do everything that you currently do? Or would they set boundaries?

A cleaner will help with the symptoms, but in your heart of hearts what do you believe will treat the underlying cause?

Is there any way you could do short hours over more days? Four hours every day instead of twelve hour shifts - giving you less build up of stress each day?

And just get a cleaner, ironer, gardener, odd job person etc. Sod working class ethic. You and your DH must know people are crying out for a bit of extra money from unskilled labour. It's the working class whose jobs have been erased from society. So your roots should make you proud to be able to pay someone to do that job.

Hang on a minute

Whilst i am fully supportive of cleaners and gardeners and all manner of support (being a grateful recipient of cleaners and gardeners and all manner of support) this is not a thread about overwork

The OP is working 20 contracted hours which develop through her kindness and consideration into 24 hours per week

This is not a thread about overwork and it's doing a disservice to the OP to characterise it as such. This is a thread about the OP's mental health,

Does the lab not call through with critical results?

Ive never heard of the juggling thing. Probably because its a terrible technique!
I agree that it's about making what you do work better for you rather than making yourself work harder and better for it.
Anxiety is often worse when we try and concentrate on everything rather than focussing on what we can really control and affect.

Gardening, cleaning and household running are mental load though - Her DH sounds good WHEN he is there but he often is not and has his own stressful job with on call duties when the rest of life ends on OPs plate. Doing all the thinking about household management, most of the cleaning and home stuff, care for her Son and the keeping up with things with regards to appts, school etc for him is too much mentally when she is bringing work home in her head due to the pressures and worrying things she has to deal with. I actually think that with the home helps in place and maybe doing 3 days instead of two she may be able to work shorter days with things better balanced. The other thing is to do with the load when she is at work in terms of on call at same time as all the difficult cases. There is no reason the locums can't do some of this and they are being incredibly selfish in doing a poor job when they are paid substantially more. So to me that is a management issue they need to address - being firmer with locums on what their duties are.

First of all, thank you. You sound like a very conscientious caring GP, which is why you see so many complex and chronic cases. You are clearly also conscientious in the rest of your life. You also sound like you are very hard on yourself ! I recognise some of this from myself. I don’t have all the answers, but it sounds like you would benefit from going back to see the friendly psychiatrist.

And though I agree that your stress is proportionate response to the crazy amount of high stress decision making you have to do at work, perhaps antidepressants might provide temporary breathing space ?

On the cleaner: yes get a cleaner. Try to find someone you get on well with, and let go of the guilt. If you can honesty forget about cleaning, laundry and eg changing beds that will be one thing off your mind.

Don’t be ashamed. We are all different. The friendly psychiatrist sounds like he was right, saying you struggle to accept you are human and have limits .

And maybe a different practice is worth considering. With so few permanent staff you are shouldering an enormous responsibility , and you really do feel that.

Please accept my apologies if I've got the wrong end of the stick but are you saying you do two 12 hour days a week? 24 hours a week? I understand your job is a taxing one (I was a year six teacher for thirteen years, in a terribly deprived area and worked 5 10 hour days a week so I understand stressful working environments) but can you not just put up with it for two days a week? As others have said get a cleaner and enjoy the rest of your week with your lo? It seems its more your oh's job that is causing problems. Can he change position? You sound a wonderful gp btw.

Sorry if I've misread the post, three under four here and not many working brain cells left at mo.

There are systemic problems here and OP is picking up the slack and carrying a huge mental load around additional clinical tasks and risks. It's not okay to compare that to being a primary school teacher because it concerns decisions that affect people's lives and deaths. Mistakes are made often and sometimes the consequences are the most serious. There are massive problems in primary healthcare. The mental load that OP is carrying is not being carried by anyone at the GP surgery where I'm registered and very many things are missed. For eg abnormal blood results which are not life-threatening are not acted upon, MRI findings where there is no critical outcome are not notified and the necessary referrals are not made. There is huge onus on the patients to keep ringing and asking for outcomes even though it's very obvious the calls are considered a nuisance. It's dangerous and sometimes people die from preventable illness. It's also noteworthy that the situation OP is in at work may also be mirrored in her home life. It's not a 'well I work a lot more hours than you so pull yourself together' thread. OP feels this way for real reasons. A conscientious and committed team would share this clinical load but that is not happening here, or not nearly enough. OP is very conscientious and works with colleagues, some of whom are much less invested than her. I think a lot of individual GPs face this dilemma.

I think it’s all too easy to dismiss the emotional demands of this type of role. The OP is supporting folk with chronic physical and mental ill health, is the only one providing continuity of care and is making significant, life altering decisions. That in and of itself creates emotional stress, before you think of the impact of listening to, and caring for distressed, traumatised patients.

I too have a role which makes incredible demands on me emotionally - one of the things that helps me professionally is talking support for myself. I have a therapist I see for my own mental health (not CBT, good old fashioned relational therapy) and a clinical supervisor who I talk to about the impact of my job on me - eg she’s someone I can share my fears and concerns with about some of the people I work with and she supports me to work ethically and competently. Burn out and secondary trauma are very real risks in my work and it’s important I have things in place to mitigate the emotional impact of my work on me.

I also recently started taking an SSRI for anxiety - like you, none of my usual self care strategies were working and I felt overwhelmed. I had massive misgivings about being on medication but I’m on a low dose now and it’s helped enormously to just give me some thinking space. Having more headspace has enabled me to see ways to reduce the pressures I’m under (running own business, new adoptive mum, studying for a Masters and about to return to part time job after adoption leave). I was chasing my tail beforehand, knowing something needed to give but not being able to see any way of creating space and order. It’s getting better now, my thinking is clearer and I’m much calmer.

There’s no shame in struggling or in seeking support, you know yourself that no one thing will fix it all - more likely that a number of individual changes or strategies will over time make a difference.

“I either need to get the hell over myself and go back to the nice psychiatrist”

Er yes, yes you do. You said it yourself, they were very helpful before. So go back and let them help you again!

You said your depression is situational and you are certainly under a lot of stress, but different people deal with stress differently, some are more resilient than others and it’s the negative self talk that’s a big issue.

I also think you need to be more assertive with the management at work and with your husband. You’ve taken on far too much and you need to be blunt with them about others taking responsibility and sharing the load more fairly.

You don’t need your husband’s permission to get a cleaner! Tell him you are getting one!!

You sound like an amazing GP and I really hope you can resolve this and continue working. It would be such a shame if you gave up.

Can your husband reduce his working hours a bit or would that create additional financial stress for the family?

Just another on the thread to say how much i value GPs like you. When my dh died earlier this year my GP gave me an hour just to talk (lots of other appointments too but ive never forgotten that first one). I don't like to think what else he was supposed to be doing in that hour but i was back at work paying tax after 8 weeks because of his care and help

And although i am bristling at thesearepearls' posts - they are right; this is about your mental health. Go to GP Health urgently. You know that you don't have to be dying to seek healthcare! You know that. If you have to do it for your son's sake, or your patient's sake, rsther than for your own, then do. But it is for your sake, you deserve it.

OP, I think it’s more than just the cleaner, the stressful job etc. I’m not a doctor, but you sound depressed.
Maybe I missed this bit, but what about friends? Do you have girlfriends you can go for coffee and spill? Your posts sound like you spend a lot of time in your head.
Try being with people that don’t need anything from you. Are any mindfulness classes near you? I go to one and it’s been a lifesaver. Try socialising with people you can trust to let your hair down.
Hope you find your spark 💐

gphealth.nhs.uk/

Not sure if you are aware of this but it is a service for GPs only. Based in London but they see people anywhere. I understand they deal with a lot of burn out and depression.

On a practical point you mentioned seeing your long term patients on your on call days. Is there any possibility you could work one extra morning a week where you only have prebooked appointments, nothing acute?

Very good point about seeing friends and people who don’t need anything from you.

I also did a mindfulness course and it was wonderful. One powerful thing I got from it that I wasn’t expecting was nurturing a compassionate and non-judgemental attitude to myself and my thoughts.

I quite strongly believe that some people are incredibly conscientious, others do enough to get by (basic box ticking) and others scrape through with the bear minimum. You fall into the first camp. I once read a post on MN about being overworked at work and all of the people who weren't overworked sounded like they fell into the second camp. They recognised that you can't do everything and that rather than exploring everything in great depth they just did the basics which was actually seen as enough by their employers and enabled them to be successful at moving other areas forward faster. As a GP and a conscientious one at that, I can well see why you are the way you are. This I believe may be part of your problem, but I don't believe you should change for the world.

So, I think it's the home side that needs to change. You need shortcuts. Yes to cleaner. Also if you don't already have one then get a supermarket delivery pass and do your food shopping online. I do a monthly meal plan that we shop for monthly (and do a weekly top up shop). I appreciate that most people prefer to do a standard weekly shop - could you do a monthly meal plan (repeat weeks 1 and 3 and 2 and 4) to save time? I book school lunches for the term in one go. I use Outlook like a work calendar and put reminders in months ahead so that I remember what needs to happen when. DH and I also share a daily/weekly to do list via onedrive on our phones which we can each update.

I think a lot of what you describe is modern life. I posted about this a while back and I struggle to get everything I need to done, although your struggle is more complicated.

A friend of mine is a GP. She feels the same and is emigrating. I know you say you don't want to go private but if you're considering resigning (well as an option in the back of your head and likely as a last resort) then maybe it's something worth to consider.

Ignore those who are saying ' but you only do 24 hours a week'. They have not understood the nature of the job. The reason you are not coping lies in the breakdown you gave of your clinical days. I am a Hospital Dr and no way could I do what you are doing. The responsibility of not missiñg a single abmormal clinical sign or blood test in amongst the deluge of clinical information that you are taking on board each day would be overwhelming for anyone. You sound phenomenally good clinically but your workload is unsustainable. However nice the practice, they will keep driving you until you collapse. It is up to you to call a halt and in doing so you have to accept that you cannot single handedly prop up the practice forever. To sustain a career over the next 30 years you need a different working environment. I think you need to talk w a mentor (another GP or a Consultant would be good) to help get insight into how unsustainable your job is. I suspect that in a different working environment you would be fine MH wise!

Definitely get more help at home, no one can do everything. Your husband is being unrealistic.

Maybe you also need to be more disciplined with patients, even though it’s lovely you give them all this time - it is not sustainable. I had depression from chronic ill health in my children, and no real support. I did breakdown with my GP, and he did listen. But he also referred me onto Counselling and to a computer based CBT programme. I completely got that he didn’t have the capacity to support me endlessly, but he did point me in the right direction. (I actually found the computer based program really helpful - it helped me to help myself).

You can’t be there endlessly for everyone, I think you need to put some definite boundaries in in your work. You will burn out otherwise, and that sounds like it would be a huge loss.

Only read half the thread as running off so please forgive me if this has all been said before.

Another GP here. One thing which leapt out in your posting was you saying that you didn’t think it would be different anywhere else. That isn’t true actually and you don’t have to stick in your current post which sounds utterly gruelling and extremely unsafe. It is a sellers market out there and a lot of good practices are desperately trying to recruit. I work more than you (6 sessions) and am also doing emotionally and physically draining 12 hour days but in a lovely practice where we support each other and offer a great service to our patients.

Join doctors.net and post this in the Couch. You will find a lot of good careers advice and support as well as the wonderful support you have here. Take a few months off, enjoy your kids, regroup and go from there.

Consider all your options.

A smaller practice is likely to have better retention, certainly all of us on our vts are looking for gms/PMS rather than apms places. Or look at more of a portfolio. What about ooh? Home triage? A gpsi role? Talk to your local gp safehouse about burn out, it's so hard to see in ourselves. What about locumming yourself for a while. Its such an employee's market at the moment that you won't risk not getting the work.

It sounds incredibly hard and you are doing a great job.

I am not a medic but at our GP practice they have pharmacists dealing with prescription issues and doing telephone consultations for medication queries and advice. My DH spoke to a pharmacist about his hay fever and he sorted out a new prescription for him.

No advice really but saddened that there are so many nhs workers who feel like you.

What advice, treatment would you recommend to a patient in your situation? Can you use that as a starting point.