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?!!

“ Is there any way you can ask MNHQ to edit or delete the posts you feel are identifying, rather that delete the whole thread ?”

Good idea. And the whole thread will be deleted in 90 days anyway.

Haven't read the whole thread but have read the op.

Leave. Hand in your notice tomorrow.

It is not your job to save the NHS or this practice ( youre salaried not a partner don't forget!).

Locum 2-4 sessions a week for a bit. Plenty of work out there. Set terms and conditions of 15-18 patients plus additional pay for visits. No on call. Get your life back a bit and then decide what to do from there

C.o.i.Gp partner in a small functional practice with good financial reward. worked as a salaried in dysfunctional practices before and was miserable so know where you are coming from!

“ Is there any way you can ask MNHQ to edit or delete the posts you feel are identifying, rather that delete the whole thread ?”

Sounds like a decent idea maybe?

Before it might go can I ask, and sorry I've not done sooner, what is a HSP?

OK, so following my panic last night about identifying information, and given that MNHQ in their wisdom haven't yet deleted the thread, I've asked for some of my posts to be edited instead. We'll see what happens (I've not had any response yet, so they must be busy!).

I agree this is a useful thread for other GPs/ HCPs as well, and I'm very grateful to everyone who has given their time and thought to posting.

I'm feeling much better this morning having worked through things on here, and slept much better. I feel as though I now have a plan.
I've also had a chat with DH yesterday evening, and we're going to look into getting a cleaner .
I had a text from the practice manager (hence the panic!), but I think she was just checking in because I hadn't seen her all week. And actually she's lovely and I wouldn't mind her knowing the things I've disclosed on here. I have asked to not be on call every day in September, as it is having a negative impact on my mental health. Not sure what can be done to avoid it, but at least I've asked!

shady HSP = Highly Sensitive Person (as researched by Elaine Aron). I score full marks on the questionnaire. That and the Myers Briggs typing have helped me a lot in realising why I react as I do, and why I struggle with things that other people cope easily with, yet often notice things that others don't. HSP

Hi. I've reported the thread for you, explaining you were worried about identifiability, and had an email to say they'll take a look at it. Hope that helps. Oh, and do wander over to dnuk. Most of us don't bite...

If I was a dr married to a consultant I would have a cleaner, gardener, Roomba for each floor of the house, mobile car valet fortnightly, professional decorator, personal shopper sessions. I wouldn't feel the least bit guilty either.

I really think you should get the house stuff done, it's nice to come home to then.

I am 99% certain my consultant in-law is not decorating his own house on his days off.

I have two ( female ) friends who are consultant anaethetists and are married to ( male ) GPs.

One family has three kids and the other has two. Both women work part time and their husbands also work part time. I think they do about 6-8 sessions a week.

So it would be perfectly possible for your husband to reduce his sessions and for you to increase yours, so that you could do the same amount of work in more hours and get paid more ( as someone suggested up thread ).

And he could share some of the domestic responsibities that he claims are joint but in practice it’s all to you. On other words, put his money where his mouth is.

If you suggest that to him, I expect you will find that HE has hired a cleaner by next week.

BTW both the women say that their jobs are easier and less stressful that their husbands .

I also know another ( male ) GP who works 6 sessions a week and supports 4 kids and a SAHW on that income. He also does weekend and holiday sessions at a deputising service, which are very well paid.

Personally I think he also likes avoiding family life at weekend and having plenty free time during the week so he can go cycling. His wife doesn’t care as the kids are usually at the GPs. But that’s another story.

www.bmj.com/content/362/bmj.k3638

OP here with an update:

I had my two weeks annual leave, tried to rest, have some time out, not think about work. I felt better in myself as long as a wasn't thinking about work.
I returned to work with some anxiety, but hopeful that there might be light at the end of the tunnel, as I had been informed that a new GP had been recruited and would be starting in September.

I found no change, still on call all the time as the new GP 'can't do on call' for family reasons, a long list of complex patients awaiting my call as they had been handed on by the locums who had seen them whilst I was away (fair enough, not easy cases to deal with without continuity).
Staff morale is at a new low point. Two more admin staff have resigned.

I lasted less than a day.

So, I'm currently on sick leave. I have seen my own GP, who was very kind. I have a follow up appointment in a couple of weeks. I've also self-referred to the GP Health service, and have been offered an assessment appointment.

There are lots of options, but I'm quite clear that I cannot go back to work at my current practice unless significant changes are made so that there is some way of managing the workload safely. I don't know whether that will be possible.

Now that I've stopped, I'm aware that my mental health has taken a beating, and that I'm really not myself at the moment. This has built up gradually over a couple of years, as the pressure at work has increased. I feel really panicky thinking about work, but I'm fine with everything else. I'm resting, talking to friends and family, and waiting for the exhaustion and anxiety to settle before I make any decisions.

Thanks again for your advice and support.

Sorry to hear a sad update but I think you have made a very sensible decision to seek help. So sad that people are being pushed to such breaking point by unsustainable working conditions. I do hope you recover and can find a more tolerable way of working. You would be a great loss to the NHS but your health comes first.

I thought I'd update in case anyone is interested, before the thread disappears...

I'm still off work and having weekly therapy through GP Health. The Psychiatrist who assessed me initially was very clear in their diagnosis of burnout. I am not depressed, and not mentally ill. According to them, I am suffering the natural consequences of trying to continue in an impossible work situation. The anxiety symptoms were a reasonable reaction to the level of risk and the lack of control, and they've settled completely away from work. I do now recognise the symptoms of burnout in myself, although I couldn't see it when I first posted.

I have been advised to have a complete break from anything work related, and that there's little that can be done other than to give it time, but it's been very slow progress and I have had a lot of frustration at the lack of improvement, and guilt at being away from work so long (which in itself is part of the burnout apparently!). I've only really started feeling significantly better in the last week or so.

I have hired a regular cleaner, and the house is now cleaner and more tidy than it has been in years (although still no decorator, as I can't cope with the upheaval currently). I recognise that I have replaced work responsibility with yet more home responsibility, and am working with my therapist on the reasons why I tend to martyr myself and feel very guilty at doing anything that's just for me.

The burnout has arisen due to the exceptional pressure and workload at work, and lack of control over the workload, combined with my tendency to believe I have to take responsibility for everything, combined with my disillusionment over the state of modern medicine and the NHS (over-medicalisation of what are largely societal problems, lack of social and mental health care), and, surprisingly to me, unresolved grief over the loss of my academic identity.

I am assessing my options, but would at least like to try to go back to general practice in some capacity. Work are being very supportive thus far, but I haven't yet entered into negotiations over workload/role in order to return, so we'll have to see how that goes when the time comes.

This thread was the tipping point that allowed me to recognise how much I was struggling. Thank you for your support, comments and suggestions.

So much of what you say resonates with me. I'm not a doctor but was a community midwife specialising in home births. The responsibility was huge, the back up inadequate. Add into that the scapegoating and witch hunting whenever there was a problem, just burnt me out.

Ironically, I have a background in clinical risk management yet it was text book poor in my "leading" NHS trust. After my last experience of "support" , I resolved to never attend another birth. And I haven't.

Thanks mayhew. So many of us in the same situation, it makes me sad to think of what the NHS will look like in future, if it survives

Glad to read your update OP & wanted to give you a cheer for all the steps you have taken down a new path.

I was on the thread earlier under a previous user name, and as another healthcare escapee your posts resonated strongly with me.

I think there is a damaging Dogma in healthcare that our patients neeeeeed us. It has created a culture of extreme presenteeism and unsustainable workloads. The more keenly we feel this, the more vulnerable we become. Yet it isn't our fault that we can't do an impossible job.

I'm reading that you are being much more honest with yourself - a hard lesson for those of us in the of course I'm fine club - it's such an important step though 

Whatever direction you choose, have fun doing it OP - I wish you well.