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?!!

I have put my foot down over electrics/ plumbing and anything where there is a safety issue - we do get professionals in for those jobs.
I agree that decorating is skilled work - my grandad was a decorator! DH unfortunately doesn't see it that way, and I think he worries that he's not like his own dad, who used to do all the DIY/ decorating and car maintenance, but didn't have the workload or income that we do.

tiredgp
I am a doctor (psychiatrist) and have dc. A few things stand out for me from your posts.
Firstly, your daily GP workload is ridiculous. It seems to me that you are being expected to do about 4 (?5) days work in 2 days. I understand why this is, and that it is due to situations largely beyond your control but I really don't think it is sustainable for you, as you are realising.
I have worked in an inpatient job with similar issues. We were very short staffed and at the time I was working 3 days a week. They actually approached me to see if I wanted to increase to 4 days, but I didn't as I wanted that balance of time off. What ended up happening though was they didn't manage to recruit anyone else and as the most senior person there I ended up doing about 5 days work in 3 days a week which was horrendously stressful and not sustainable. There were constantly things I didn't get time to do, despite working very long hours, and I spent my days off worrying about work stuff. Looking back I wonder if I should actually have increased the days I worked as I would have had more time to do stuff and been paid for it and then maybe been able to use my time off more productively. In the end I applied for and got another job (a community job, with a brilliant team which I am fortunate to say I love and have been doing for 5 years) SO...one option (although it is counter-intuitive) may be to actually increase your working hours . This would enable you to spread some tasks over more days (eg reviewing blood results) and having more space for regular appointments so they don't have to be squeezed into on call days. Plus it may enable you a chance to deal with some of the easier /nicer stuff which I think is also important to create a balance for you.
Also I have gradually over the years learned to be much more assertive and boundaried. This is not something which comes naturally to me , and like you I also struggle because I care a lot about my patients. But , during my very stressful inpatient job I did learn to say no a bit more. I sent many emails to managers explaining why certain things would not get done and the possible risks of that and making sure I kept copies and documented everything. It was not a nice way to work, but you do have to draw the line somewhere. Can you look again at what you are being asked to do and maybe be firmer in stating that there are some parts of it you can't complete in 2 days a week? And there is also a skill to be learned about not dwelling on things on your days off.
Alternatively i wouldn't rule out looking for another position, although I accept in the current climate most GP practices would have similar issues.
Definitely get a cleaner/housekeeper/as much help as you can afford.
In the past I have struggled with the idea of a cleaner as I was perfectly "capable" of cleaning myself. But as others have said I realised that just because I COULD do something didn't mean I had to! I am perfectly capable of baking a loaf of bread - doesn't mean I don't buy bread from the supermarket! I am perfectly capable of driving to the supermarket - doesn't mean I don't order the shopping online and have it delivered (definitely do this if you don't already btw!) etc... For me having a cleaner was about CHOOSING how to use my time. And yes, also giving someone else employment with a decent wage and treated well etc
I also do all the thinking/planning etc for our dc and you should definitely not underestimate how stressful that also is. I use daily lists to help me stay focused and stop me feeling overwhelmed. I list everything for a certain day in my diary eg Monday - fill in dc bus pass forms, Tuesday - finish ds school application, Weds - order dds new school blouses and I try not to attempt too many things in one day.That way it stops me procrastinating or just not knowing where to start! (admittedly I have 5 dc so there is always plenty to be done...)
Go away and have a lovely time with your family and don't think about work. I would save any thinking/talking about it till the end of your time off - you need a few days to just switch off and relax.
Hope you find some solutions.

also, as an aside, it is horrendous that it takes 12 months for patients to be seen by your CMHT. Where I work patients referred to our SPA are seen in 2 months and in our team we are commissioned to see people within 2 weeks! Having to manage those people with significant mental health problems in primary care is not on really and I imagine is very stressful.

I think my GP was dedicated like you. She only did a couple of days but she was working incredibly hard when she was there. I was one of those long-term mental health issues patients and she literally saved my life. Mental health services were crap but she never stopped pushing them for more help for me and then she was there in between. She was far better than any of the so-called specialists anyway. I would definitely be dead if it hadn't been for her.

Anyway, she's given up being a GP now. Probably partly because she has kids, partly because of draining patients like me and partly (I know, as I was told) because the system/ NHS/ GP workload was getting too much. I massively miss her. We need people like her and like you. You make a difference. But you can't do that if you burn out and get ill or leave.

I don't have any answers, but I hope you find a way to make things work for you and, if you do, it will benefit your patients. But you have to come first.

Would it help if I said I'm in Palliative Medicine and it's not all that as a consultant?

I came early to feminism because of a Scandi DM, and then even more so because of Mumsnet but Doctors.net has been a big influence on me as a doctor - makes you part of the awkward squad in knowing not to get walked all over. I still do get walked all over, possibly an INFJ thing, but it could have been far worse. It's not as active a site as it was now social media has taken off, but The Couch has good people as does the GP Forum. You need to learn when to say NO.

I think you need to sort out some sort of counselling for yourself, via GP Health. This is not a bad thing - in Palliative Medicine it's totally normal for everyone to be having Clinical Supervision, I think it's a shame it's unknown in other specialties. You may also need this too, not just a limited length period of counselling. You have work stuff to sort out but also stuff about how you manage your home life too - in my supervision I remember practising sentences of how I was going to ask my DH to do the ironing In my work life I was a fulling functioning lead clinician at this point DH is actually a kind and sensible human being if prone to idleness.

The other thing is, is palliative medicine still completely out of the window? Are there any opportunities for you to this as a Specialty Doctor at hospices/palliative care teams near you. These roles don't come up often but are generally hard to recruit to and often are advertised for ages. Hospices in particular often struggle to cover their on call rotas - the money is crap compared to GP which is why no-one wants to do it but the workload is completely different to what you describe. One of our portfolio GP said I get paid for a day what I get paid for a halfday in GP - but I actually work a day, have a lunch break and go home on time, in GP they'd pay me a halfday and I'd really work a whole day with no breaks.

Believe it or not Anna, I am a lot more assertive at work than I used to be! 3 years as a locum with a small child sorted that out. I do push back at work, but there's nowhere for the work to go, and the lack of on-site senior management means that I have to sort out the delegating myself, and it's often quicker just to do it myself. And yes, the INFJ thing makes it hard to maintain that in the face of overwhelming need.

I actually worked as a locum hospice doctor for several months and loved it. They offered me the permanent post (as you say, for a fraction of the pay), but I would have had to give up the academic job, which I wasn't yet ready to do, and also we were in the process of moving house in a direction that would have made for a very difficult commute.

The hospices local to here are much bigger and have full training programmes, so they don't seem to need specialty doctors any more, as they can cover the on call with trainees. I do keep an eye out/ ear to the ground, but I think it's fairly unlikely that anything will come up within commuting distance.

moss thank you. I have thought about increasing hours. They've recently agreed to pay me overtime for the additional hours, on the basis that it's essential clinical work, until such as time as we can recruit. I've resisted getting an external login for the computer system, as I wanted to try to keep work and home life separate, but it appears that ship has sailed, so doing a few hours of admin work one morning a week rather than staying late might be a better option.

neverknowingly helping patients like you is one of the great privileges of my work, and I really believe that it's probably the most valuable thing I do as a doctor. I would just like to be able to give my patients the time they need without feeling the anxiety of an unknown, unpredictable workload stacking up. I'm sorry your GP felt the need to leave the profession. You are not a burden, you're a valuable human being and deserving of help and support.

I definitely got support, but I always felt (and especially feel now) very guilty. She'd see me at the end of surgery so that I could have more time. An hour, once, when things were especially bad. I had four years of amazing support and sometimes I didn't even want it - I wanted to be left alone to be suicidal, but she'd call and make me come in. If she had ten patients like me...that's a massive cost to her personally and you sound similar. I work in an industry where maybe 10% of "clients" have problems. I don't know how GPs do it. All of your patients are there with a problem. The emotional toll must be huge. But you make a difference.

Don't feel guilty. In Buddhism, there is great merit in allowing people to help you, because then you are helping them to create good karma.
I am very grateful to my patients over the years, because they have made me a kinder, more empathic, more tolerant human being.

There's also nothing more rewarding than seeing someone feeling better after they have struggled, and knowing that you helped them to get there.

I'm struggling to relax at home, and getting hung up on all the stuff I should be doing and aren't, and I seem to lack motivation when not at work, so I don't do stuff and then get stressed because it's not done

That's depression and anxiety right there, isn't it? What would you prescribe for me if I came and told you that?

(Also - get a cleaner)

This is all in your head.

You have lots and lots of free time. Sounds like you a lovely home and family with plenty of financial income.

There are people out there with far, far greater problems to deal with on a daily basis.

The workload is high and stressful on your 2 working days. However, this seems a perfectly proportional trade off to the seemingly nice life you have for the other 5 days.

You have surely got to be questioning whether this is the job for you, if it’s causing you such burn out at this level. Although, I’m sure you’re aware that large sections of your posts sound like they were written by someone with very real mental health issues. Read them back to yourself, pretending you are a neautral bystander reading someone else’s writing. As a GP, I expect the red flags will be glaring.

OP you sound amazing!

I have done your job, part time as you have. I remember my half day lasted from 8am till 3pm! And I remember that fear of missing things, of never "being enough", of trying so hard but being so stretched.

I don't do that job any more. I work in another specialty and I am content.

If a palliative care specialty job isn't an option, what about a different specialty? If you love working in mental health, psychiatry could be a possibility. Others that have come up locally where I am are dermatology ones, GPS to work in breast clinic, or sessions in the endocrinology clinic for GP with special interest in diabetes. Perhaps there are similar possibilities near you.

It's about time, isn't it? Having the time to give to each patient. In my experience, modern day general practice isn't great for that. Too many demands, too little time in which to meet them. Too little time to give to each individual patient.

Other kinds of posts (as mentioned) may be less pressured, so more time to give to the individual.

Essentially you have a job with "high responsibility and low control" and that is a recipe for feeling stressed.

Hi again, I'm sorry I've not had as much time to read and answer your post as I would like. Can I revisit this issue..

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

I can appreciate that, my close rel of mine is a consultant (we're from very working class backgrounds) and has always done her own cleaning but she did hire a gardener! I would be thinking of saying to DH in your shoes, yes we are capable of doing these jobs but that's not the point, time and your good health are not allowing it. Apologies if you have answered this already but does he know exactly how you feel as you spelt out in your post? He needs to listen to what you need and like you said, revisit the question. You could easily give your laundry to a company to do also, or at least the bulk of it. Same with the cleaner, perhaps someone could do the bulk and DH could do a bit as well so at least he feels like he is still doing some of it! Also, taking a wholistic approach, there's probably someone out there who would love the job of taking care of house for two doctors, could be someone's dream job.

At least then you would have more time and energy for yourself, the parenting and the rest of it, eg endless school admin. I used to say school stuff was a whole job in itself, also my 2 had health conditions and I was sorting out endless hosp appointments and prescriptions...DH probably never realised half of what I did/do and I am wondering how much yours is the same, esp as he is not there an awful lot?

Hope you are getting some help on here because you sound great and you certainly deserve it.

Hello,
My apologies as I haven’t read your whole thread so I do not know how it’s developed. I saw your first post hours earlier but couldn’t respond then. What I wanted to say was that I could relate to your situation very clearly, even though the details are different.

I am a hsp and introvert with a front facing, important job where there are constant constraints and challenges. What has helped me to navigate my response and re-order the way I work and approach all sorts of things in my life has been The Lightening Process.

It’s a three day course which mainly helps a person with several key areas: To identify what a person can/can’t influence in a situation. Make a plan for the things you can and gives a ‘tool’ to change your thinking regarding the things you can’t change.

I found the investment in making time for this course, and organising the childcare was very much worth it.

I felt in a similar situation a few years ago with work, albeit in a different field. I held myself to very high standards which I explored in depth after a period of illness.

Ultimately I had to let lots of things go and stop being such a martyr/perfectionist. I had to accept being “good enough” instead of the best. I got a cleaner and it made a big difference. I also cut lots more corners and make life as easy as I can for myself as often as I can. I pay other people to do stuff for me as much as I am able. Sometimes I get the occasional guilts about not doing it all, but my life is better for worrying less and not trying to be the ultimate employee/wife/mother/daughter/friend etc.

I am a better quality version of a less perfect person than the worn out perfect person I was before. My family and friends prefer the more imperfect me.

OP - get as much help as you can, rest as much as you can and let as much go as you can. If you need time then take it. Wishing you all the best - you sound lovely and deserve to be happy.

OP, you sound very overwhelmed & yes, there are elements of anxiety & depression.

Can I ask: which came first, the job or the mental health issues?

I hope your break away gives you some distance & clarity & you are able to come back with a different perspective.

I was the caring, listening, "5 session" GP who worked 40 hour weeks in 3 days, struggling with recurrent depression and anxiety, and excessive workload until I burnt out 5 years ago. I resigned from my practice with the aim of locuming after a few months off, but I am now happier as a SAHM. I miss medicine and would love to return to a role with a manageable workload, but I still have nightmares about over-running surgeries if I start to think about returning.

Be kind to yourself, do what YOU need to do for YOURSELF, not what you think everyone else needs. It's time to be selfish. 💐💐 Good luck.

Another INFJ part time GP here who can relate to much of what you have written. Good listener I’m told so lots of patients with complex problems, esp mental health issues. Which I actually love trying to help with under less pressured circumstances.

Have just decided to leave general practices in the past week. It feel like a huge relief. But so much guilt too re my patients and colleagues.

I’m going to keep doing Out of Hours which I find less stressful. And hopefully some A&E shifts. It’s not sick people that stress me, it’s the landslide of paperwork and responsibilities for things like people getting benefits or not depending on how I fill out the form.

Longer term I’ll probably become a counsellor and hopefully use my skills that way.

No advice OP but can understand how you are feeling.

I'm also a salaried Gp, 5 sessions in a v busy practice, 1 ds aged 2yo. Although where I work is extremely busy it is no where near the extent of your workplace, which frankly sounds like it's in dire straits and an accident waiting to happen. It seems inevitable that in such difficult circumstances you will make mistakes.

I agree with a lot of what has been said before but I'd just like to add that there is a shortage of GPs in the Uk which actually puts you in a strong position to negotiate with your practice manager. However, I would set a time limit for them to make the changes you feel you require to make working there sustainable, say 2 months.

If they fail to deliver then I would suggest handing your notice and looking for another job. There are lots of nice practices who would love to have you, there are plenty of vacancies.

Have you considered asking for them to pay you for an admin session? My contract specifies I can only work a certain number of oncalls per week, have you checked your contract?

www.rcgp.org.uk/training-exams/practice/gp-wellbeing/wellbeing-help.aspx

@ChocolateDoll - ODFOD

I bet the same people who are telling the OP she’s living a charmed life and it’s in in her head are also the people who would be the first to complain if they felt their GP was running over time, was rushed, wasn’t empathetic and didn’t follow up on results ASAP.

It’s a hugely responsible job and the anxiety that it provokes about missing something important isn’t the OP catastrophising. It’s a genuinely worrying.

I am a GP too and work 3 days per week. I know what you are saying. The long days are absolutely the pits and the paperwork is unbelievable.
My husband works at home so that is great because he cooks me tea and the house is always warm ( winter here).
I am the main income earner though which is stressful.
I am like you. I typically run late. I try really hard and give it my best.
In the last few weeks I have had 3 lots people unhappy with me and I have been in tears at work.
I am having to make some decisions.
I have decided to have some professional supervision, to make sure I try to get out of my room, outside and walk fast 10 to 15 mins at lunchtime. Exercise makes a huge difference. I am also realising , actually realising that extreme stress and no break in a 12 hr day makes me unsafe to practice and I need to let myself and colleagues know that I am practicing self care. It is hard because it means walking away and saying no.
The health system functions because brilliantly compassionate and hardworking providers - nurses, doctors, physics nurses and the admin staff that support us are compromising our own mental and physical health.
Virtual hugs🌻🌻

Thank you for your contributions. This has been enormously helpful in sorting out my thoughts, and I have checked out the links and suggestions, and will be following up on some of them. It has helped a lot to hear from other doctors and nurses that the workload is indeed as bad as it feels. I now have a coherent idea of what to try next to make things better (step 1 - get a cleaner!).

for all my fellow GPs, Drs and other health care workers, past and present.

for those of you who have struggled with health issues and bereavements, and had support (or not) from your GPs.

I've read through the thread and realised that in my enthusiasm to respond, I've given rather a lot of potentially identifying information. So I'm going to as for this thread to be deleted.

Thank you everyone and all the best.

Have you checked your vitamin D levels and/or are you supplementing with vitamin d as living in the north of england and given the schedule your are describing, you are almost certainly deficient. You need vitamin d for serotonin uptake. Also, some Omega 3's might help too.

I live in the USA, but have lived in London in very underserved areas and seen practices like yours. Here in Los Angeles, I have Medi-Cal which is the government provided health insurance for low income people. My GP has a fantastic practice and he always looks relaxed. I don't know if this is possible with the NHS. He has medical students from a small off shore not very prestigious medical school doing rotation with him. And a Physicians Assistant. So the system is that when I go in for a checkup, or minor ailment (UTI or swollen joints), I get seen first by the medical students (sometimes I mess with them, just to keep them on their toes) who make clear that they are students and learning. They do the basic checkup and questions. Then if it's anything more complicated, the PA will come in with the students and then if it's more complicated, the GP comes in too. All the students sit at a big round table at the back of the practice with the GP and PA and go over everything with him. I have always been seen by the PA after the medical students, but not always by the GP. However, on the rare occasion that I have asked to see the GP, he was always available. The process takes longer than if I were spending 10 minutes with a GP, but in the end, I feel better taken care of because I know that multiple eyes are looking at my issues AND the GP has to keep up with current research to train the medical students. This seems to take a huge amount of pressure of the GP. The patients always seem happy and I've never seen someone complaining about lack of care the way I used to all the time at my various NHS GP's that I had in London. Appointments are always easy to get and they take walk-ins every day except Friday, but if it was urgent, I'm sure they'd take a walk-in on a Friday too.
Again, I don't know if this setup is possible within the NHS, but it sure seems to work.

One last thing, before you go OP.

My recovery has 4 elements and I believe I needed all of them.

1. ADs I took for 9 months. Helped my brain to quieten down which enabled me to take positive steps towards recovery.
2. exercise. I took up running in a local forest. Beautiful, even in the middle of winter, I always come back feeling better and it was/is a good place to be alone with my thoughts.
3. regular counselling. Weekly at first, then monthly, to work through the underlying causes and the way I react to things. I learnt some excellent coping strategies that I continue to use. It also helped me to understand that lots of the things that I worried about weren’t entirely rational or within my span of control.
4. removal of the underlying factors, As each layer of pressure was removed, my mental health improved - but I was conscious that I also needed to continue with 2&3 to recover.

Good luck with your recovery, you know the toolkit you need to use and you don’t need permission to access it. Allow yourself to get better.

OP I think this thread has a lot of very useful information in it, especially for other GPS and HCP who may feel like you. Is there any way you can ask MNHQ to edit or delete the posts you feel are identifying, rather that delete the whole thread ?

Just a thought. You must do what you feel is best.