The effects of the Covid-19 pandemic are rapidly rising and encroaching on everyone’s everyday existence in this country. These are unprecedented times and general practice has had to change to keep up with fast-moving developments.
Being a GP is not easy and GPs certainly don’t have the monopoly on job stress. But the Covid-19 outbreak is undoubtedly generating more stress and strain for the majority of GPs, as well as our patients.
GPs are often one of the first ports of call for a health problem and they have had to adapt and rapidly change long established tried and tested working patterns. There has been a rapid rise in remote working coupled with a dive in the numbers of face to face consultations, often being replaced with telephone consultations.
The speed of change is breathtaking, and although many GPs are uneasy about this dramatic and sudden change in working patterns, the vast majority are slowly getting to grips with it. The General Medical Council has already provided some advice.
GPs and ability to bounce back from adversity
Dealing with the undoubted stress of everyday practice makes us think about how we manage these stress levels, and this brings up the concept of resilience. Over the last few years, I have seen a lot written about GP (and doctor) resilience. It is important to find a good, understandable and practical definition of this concept. One good definition of resilience comes from a collection of articles on resilience from the British Journal of General Practice. Within the introduction of this article collection, it is stated ‘Resilience’ means the ‘ability to bounce back from adversity.’
Within this useful collection, one article also had a particularly good definition of resilience where it is described as “a dynamic process encompassing positive adaptation within the context of significant adversity”. Another article makes the important point that when GPs are part of a unit that can work together as a unified and supportive team; this improves both morale and resilience.
Helping GPs enhance their resilience does sound a good idea because job stress can take its toll. According to a recent blog published in BMJ Open “nearly one in three UK doctors may be burnt out and stressed.” The specialties of Emergency Medicine and General Practice were prominent in the research and there is a link from the blog to the original paper.
From a GP perspective, I am sure we could all name a huge list of factors contributing to increasing our stress levels; these include ever rising unsustainable workloads, crushing bureaucracy, low morale, rising levels of complaints and patient dissatisfaction as well as poor support from management and the political establishment. These are to name just a few of the factors, and I am sure the list could go on much longer.
Interestingly, I wonder if as a result of the Covid-19 pandemic, GPs and other healthcare professionals may improve their levels of morale. After all, there is good political and financial support for the health service and many people seem to appreciate the work that healthcare professionals do. Equally, there is more purpose to our role in this crisis, which could make us feel more valued and appreciated.
Retired doctors at increased risk of mortality from Covid-19
Although we would like to support all GPs and doctors by increasing their levels of resilience though that is not always easy to achieve but what about looking at the problem from the other direction? Instead look at some of the causes of the burnout and stress and yes some may emanate from the individual and their unique characteristics but what about the institution?
In this case we are talking about our ultimate umbrella employing organisation, the NHS. In one blog, the author makes the excellent point why not improve the working conditions for all the NHS staff? This could perhaps reduce the stress levels of the staff and make a more productive, happy and resilient workforce. Of course, the individual also has responsibility in this matter but equally, so does the employer.
In the current Covid-19 crisis, I have seen many times appeals by the government to retired nurses and doctors (especially recently healthcare professionals), to return to help their current front line colleagues. It does seem a noble cause and I am sure some will respond because of duty, the challenge and will relish the return to a career they once enjoyed. However, there will be a significant number of recently retired healthcare professional colleagues including GPs who retired early, who were fed up with their working conditions and sadly could not wait to leave.
A significant number may not want to return under any circumstances, not matter how high their resilience levels have become. Equally important, this cohort will likely contain people who are at increased risk of morbidity and mortality from Covid-19.
Recovering from the Covid-19 pandemic is everyone’s main concern but when we look back at these events when (hopefully) they are behind us, there are other things we need to look at. One area that should be examined is the resilience of the NHS and all its staff.
Dr Harry Brown is a GP, Leeds, and medical editor of GM Journal