Intended for healthcare professionals


Burnout is harming GPs’ health and patient care, doctors warn

BMJ 2021; 374 doi: (Published 19 July 2021) Cite this as: BMJ 2021;374:n1823
  1. Gareth Iacobucci
  1. The BMJ

High levels of stress are severely harming the health of GPs and their ability to provide care for their patients, doctors have told MPs.

In a parliamentary briefing on 15 July representatives from the Doctors’ Association UK and the campaigning group GP Survival said there was a crisis of “unprecedented scale” in primary care that needed urgent attention.

John Hughes, a retired GP who now chairs GP Survival, said that the pressure on practices had intensified because GP numbers had not increased in line with surging demand, and ministers’ pledges to boost GP numbers had not been delivered. Constrained funding relative to the hospital sector, negative media coverage, and high levels of bureaucracy necessitated by the NHS and regulators had also contributed to GPs feeling burnt out, he added.

“GPs are leaving at a rate of three per day. There’s a major exodus from the profession,” Hughes said. “Over 20% more GPs are reporting burnout than a year ago, and GP suicide rates are up to four times the national average.”1

“We really do have a profession in crisis,” he concluded.

Louise Hyde, a GP in Powys in Wales, told the briefing how she had stepped down as a GP partner at the end of 2019 because of the “pressurised, very intense” workload, which had seriously affected her health. “I was finding that even on my half days I couldn’t always finish my clinical work in time to pick the kids up from school, and then I was having to log back in after bedtime to do my admin work,” she said. “I was irritable, I couldn’t stop thinking about work, I was miserable with the children . . . and I started to feel quite guilty. Eventually I started to have suicidal thoughts and nasty mental images of harm happening to me, and I sought help from my GP.”

Hyde said her practice was able to draw on the work of an experienced locum GP, which allowed her to take a step back. “I am incredibly grateful to her, because I think she probably saved my life,” she said. “I had two months off, I came back on a phased return, and I realised that the workload was so intense that I was going to struggle to manage to achieve work-life balance as a partner.”

Lizzie Toberty, a GP in Newcastle-upon-Tyne, said that GPs’ own health and their ability to see patients were interconnected. “I think that it’s becoming all too common for people to function at high levels of stress and anxiety,” she said. “Our patients benefit most from seeing a relaxed, calm, ‘in control’ doctor, not a doctor who is frazzled and stressed and aware of how much else they have to do.

“That needs to be recognised. We need to be well rested, on the ball, and able to be empathic and really give them [patients] a good level of care that they deserve.”

Shan Hussain, a GP in Nottingham, said that investing in prevention, developing a positive vision for general practice, and tackling the bureaucracy in general practice were all factors that could help to reduce pressure on GPs. “We have many measures such as appraisals, revalidation, CQC inspections . . . which have very little scientific evidence to support their use yet are imposed unilaterally upon us and cause remarkable distress,” he said.

Clare Gerada, a GP and medical director of the NHS Practitioner Health service, said the programme had seen a “staggering increase” in doctors seeking help over the past 12 months, with GPs still the largest in number, at 1995.2

“We have to address the workload,” Gerada told The BMJ. “We can’t have 12-15 hour days. We need an equivalent to SAGE to look at what we do about the GP workforce and demand crisis. It should be chaired by a primary care physician [and] involve patient groups and perhaps the NHS Assembly.”