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LMC help for GPs suffering stress

Dr Roger Crabtree on the scheme that Somerset LMC and PCT provide to support GPs with stress.

Stress: with an increasingly demanding role, more GPs are suffering from stress-related problems (Photograph: SPL)
Stress: with an increasingly demanding role, more GPs are suffering from stress-related problems (Photograph: SPL)

GPs provide expert health advice and action for the public on a confidential one-to-one basis, essentially for all comers. That this is stressful is hardly surprising.

In Somerset, our GP LMC secretary had for years supported GPs and practices through tough times. By 2008, he was leading a small team of myself and two other GP LMC pastoral officers, with a growing caseload.

Colleagues were ever busier, clinical days remorselessly lengthening. Add in the pressures of the ever-changing NHS plus GPs' understandable reluctance to 'break cover' over problems with stress or symptoms of burnout and we felt something more needed to be done to reach colleagues who were struggling.

The PCT, LMC and local dental committee (LDC) set up the Somerset Clinician Support Service (SuCceSS) in 2009 for the county's GPs and dentists.

Confidentiality essential
Right from the start, confidentiality was key. The service had to be fully confidential and also be seen to be so.

Making detailed activity reports with case summaries and outcomes was completely out of the question if GPs were to seek help when this went against their instincts.

SuCceSS was initially a PCT-based phone line where a confidential administrator would pass the message to a SuCceSS advocate who would then contact the GP direct.

Today there are nine advocates: six GPs and three dentists. Two GPs are PCT patient safety leads and four, including myself, are LMC pastoral officers.

The PCT funds the infrastructure; the LMC and LDC fund their advocates' time and training. Advocates have a small but intensive caseload that can be very exacting.

We explicitly avoid publishing statistics, but initially around 15 GPs a year sought help out of a community of around 450 GPs.

This tallies with other LMCs' experience regionally. They, like us, see the figure as the tip of an iceberg.

A TYPICAL CASE

The following is not an actual case but is typical of the kind of problem that SuCceSS can help with.

Sophie is an established part-time GP whose distress was immediately evident to the advocate who took her call. She had initially described her problem as 'time management, getting worse'.

But as she gained confidence that this was a genuinely confidential discussion, it became clear there were some very deep and long-standing issues here.

Meeting clinical work quota
Of these probably the biggest issue was the change in the way the practice was being run. Everything was being increasingly minutely managed so that she, as a non-partner, now had to meet a quota of clinical work, which left little time for any personal interaction with the patients - the only part of the job she had really enjoyed.

The crisis had come when the practice manager had taken her aside and suggested pretty clearly that she was underperforming and needed to do better, and very soon at that.

She felt bullied and undermined, as if the whole of her career had been swept away by his words. Holding back her tears until she was out of sight, she had managed to get herself home feeling empty and desperate.

Online resource
By 2010, we believed we were reaching a slightly larger tip of that iceberg. But the problems were still often long-standing, and GPs had sometimes struggled for decades before seeking help.

To reach more of the iceberg my not-for-profit medical education company CPD Forum Ltd created a new online resource called Somerset Safe House for GPs giving a wide range of relevant information, plus an additional direct channel to an advocate online which is not only confidential but anonymous if the GP wishes.

Each GP was sent an untraceable passport for accessing the service.

Somerset GPs now have a wide range of solutions to the common problems they have, including:

  • Simple access to occupational health.
  • Stress and burnout.
  • Time management difficulties.
HOW THE SERVICE HELPS
PROBLEMS GPs FACE
  • Educational needs.
  • Personal development needs.
  • Interpersonal relationship stresses.
  • Practice dynamics and unresolved issues.
  • Work/life balance.
  • Pastoral needs.
  • Boredom and disenchantment.
  • Health concerns, including alcohol and substance misuse.

ASSISTANCE AVAILABLE
  • Educational signposting.
  • Personal development planning.
  • Personal mentoring.
  • Practice support.
  • Occupational health.
  • Psychotherapy.
  • Psychiatric support.

Help more accessible
From a list of the advocates' profiles, GPs can choose someone who they feel will understand where they are coming from.

They can make contact anonymously, although in practice people identify themselves fairly early in the dialogue.

Initial figures suggest this resource has increased the contact rate into the service by more than 250%.

It could arise that a GP discloses something that seriously threatens patient safety.

In this rare case (which we have not and do not expect to encounter) we have provision for a panel of the advocate, the LMC secretary and the software manager to be convened to break the GP's anonymity. The GP would be kept completely informed.

For us, patient safety has become more than simply heading off disasters.

'Dysfunction' is not an overnight occurrence, indeed much of the time overperforming is normal for GPs and they deserve high-quality confidential support for the times of struggle during their career.

The online system, Somerset Safe House, is now being offered to new areas on a not- for-profit basis.

It is a complete system of information and access for GPs and those who provide their pastoral support, and can include training for those taking the advocate role.

  • Former GP Dr Crabtree is a pastoral officer at Somerset LMC and director of CPD Forum Ltd, info@cpdweb.org.uk

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