Why are GPs suffering from compassion fatigue?

It is no secret that GPs are at greater risk of burnout and reduced wellbeing compared with the general population and other healthcare professionals.

Survey results published in the BMJ this week were the latest in a series of articles and studies on the subject.¹ The survey of 1,651 UK doctors sought to analyse the psychological impact of managing heavy workloads in an under-funded, over-worked system. It measured resilience, professional quality of life (burnout, work-related trauma, and compassion fatigue) and coping mechanisms, using validated scales.

It revealed that doctors working in emergency medicine and general practice are the most at risk of exhaustion, stress, and compassion fatigue. In addition, GPs scored lower for resilience than hospital doctors.

Burnout risk due to service demands

Professor Martin Marshall, Chair of the Royal College of GPs, said that the reason GPs, alongside colleagues in emergency departments, are most at risk of burnout is because GPs and their teams are at the front line of delivering patient care and demand for their services is escalating.

He said: “Workload in general practice is rapidly increasing in terms of volume and complexity, yet the resources we have to deal with this are inadequate and the numbers of fully-qualified, full-time equivalent GPs working in the NHS is falling. This situation is leading to many GPs burning out and leaving the profession earlier than planned.

“We also lack the time we need with our patients to provide the holistic care that GPs excel at delivering. Particularly at a time when more patients are living with multiple, long-term conditions, the standard 10-minute consultation is increasingly unfit for purpose, yet offering longer consultations would mean offering fewer, and many GP practices are already booked up weeks in advance.”

The workload pressures are only likely to increase if proposals for primary care networks to provide more preventive healthcare to vulnerable groups from April go ahead. An analysis by GPs in Berkshire, Buckinghamshire and Oxfordshire estimates that practices will face costs ‘at least in excess of £100,000 per annum’.

In addition, NHS England also announced that older and complex patients will be able to access expert rapid response teams to remain well at home to reduce pressure on hospital services. BMA GP committee chair Dr Richard Vautrey warned that the rapid response teams must be adequately trained to deal ‘properly and comprehensively’ with patients’ needs to avoid dumping more work on general practice.

Measures to help reduce GP stress

A study published in the British Journal of General Practice last year looked at why GPs have particularly high levels of burnout and poor wellbeing.² A total of 232 practising GPs completed an online or paper survey measuring burnout, wellbeing, occupational demands and support, and patient safety. In all, 93.8% of GPs were classed as likely to be suffering from a minor psychiatric disorder, 94.7% as suffering from mild (22.0%) or severe (72.7%) exhaustion, and 86.8% as having mild (37.9%) or severe (48.9%) disengagement.

Analysis showed that spending a higher number of hours on administrative tasks and on call, and feeling less supported in their practice, was associated with lower wellbeing, which in turn was associated with a higher likelihood of having reported a near miss with patients in the previous three months.

The researchers suggested two places that interventions could target. One was reducing administrative work by hiring more administrative staff and providing a more supportive environment. The second was through resilience training.

The National Association of Sessional GPs also examined the reasons behind GP burnout and workload was top of the list.³ Other areas were:

• Control – Micromanagement, lack of influence over decisions affecting their work. Reward- Not enough pay for the level of responsibility, lack of thanks or acknowledgment of their work.
• Community – Isolation at work, conflict, lack of supportive relationships at work, difficulty with a colleague.
• Fairness – Feeling of discrimination, lack of transparency of pay scales.
• Values – Feeling that administrative aspects of work are meaningless, ethical conflicts.

It said that by examining these six key areas, it may be possible to identify one or more mismatches between the nature of the job and the individual’s own personality and attributes, which may lead to burnout.

General practice is running on empty

The Royal College of GPs says that general practice has been running on empty for too long and urgent action is needed to address the workforce shortages, education and training, and the quality of working life for GPs.

There is also a cost incentive too. According to the 2009 Boorman Report improving staff health and wellbeing in primary care could save £213 806 annually per trust.⁴ 

Dr Steve Boorman’s landmark report highlighted many of the issues that are still faced today by primary care and early intervention is critical to support doctors’ health and wellbeing. The report said that a healthier workforce means fewer avoidable days off sick, reduced levels of presenteeism and a more efficient workforce.

It concluded: “Healthier, happier staff means better patient care, which should always be the main priority of the NHS.”

1. McKinley N, McCain RS, Convie L, et al. Resilience, burnout and coping mechanisms in UK doctors: a cross-sectional study. BMJ Open 2020
2. Hall L, et al. Association of GP wellbeing and burnout with patient safety in UK primary care: a cross-sectional survey. British Journal of General Practice 2019; 69 (684): e507-e514.
3. https://www.nasgp.org.uk/burnout-and-how-%E2%80%A8to-avoid-it/
4. Boorman S (2009) NHS health and wellbeing review: interim report, https://webarchive.nationalarchives.gov.uk/20130103004910/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_108799

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