I was in my car when I reached breaking point. It had been another busy day at the GP surgery where I am a partner, and I had stopped to check my emails. What I read turned my blood cold: the suicidal teenager I had worked so hard to admit earlier that day had been discharged from A&E without even being assessed by the mental health team.
I was genuinely afraid that this young person would die, but I knew there was nothing more I could do. I wept, and I could not stop. I phoned a colleague. She came and sat with me in a dark car park in the middle of nowhere and gently persuaded me that I needed to take some time off. I felt huge guilt but reluctantly agreed.
The crash, once I let it happen, was profound. I found myself anxious about making tiny daily decisions and had dark thoughts about not being good enough: if I was just a better doctor, a better leader, maybe none of this would be happening.
It took months of medication and therapy before I was able to return. I have now been back at work for almost a year – but I don’t feel able to stay. I have handed in my resignation and, by later this year, I will no longer be a GP partner in the NHS.
I’m not the only GP to feel so broken. We signed up for what we hoped would be rewarding careers in our local communities, based on long-term relationships with patients and the kind of continuity of care that saves lives. But the impact of workforce shortages, austerity policies and then the Covid-19 pandemic has slowly eroded all the quality. Death by 1,000 cuts for the service, but also for GPs’ and support staff’s wellbeing.
It wasn’t always this way. Eight years ago, I loved my job as a GP partner managing a small semi-rural surgery. Though the work was demanding and the hours long, we had a sense of control and self-determination, and knew that the work we were doing made a difference.
So, what changed? By 2019, the pots of money we had to chase got ever smaller and more scattered. The time we used to have for meaningfully improving local care was taken instead by chasing central targets and top-down initiatives. This wasn’t to secure “extra” money. These were existing funds diverted into new projects, but with so many additional strings attached that hours of our time were wasted in claiming them.
As job satisfaction fell, it became harder to recruit. We lost a partner to retirement and were never able to replace them. Now, if extra work was needed (a last-minute safeguarding conference for a vulnerable child, cover for a sick colleague, Covid vaccination clinics), this was split between a smaller group of partners. The hours and extra workload started to take its toll.
We tried to work smart to meet these new difficulties. We teamed up with other local surgeries long before “primary care networks” became a buzz phrase. We ran collaborative patient support groups and shared clinical expertise to enable us to reduce hospital referrals. We looked to recruit from a broader pool of staff, taking on a paramedic, a pharmacist, a nurse practitioner. All valuable and valued colleagues. But these new colleagues could not work independently. They needed a GP alongside to provide support. And so the hours and the workload grew and, as they grew, our pay went down – a real terms 30% pay cut in the past 15 years. This made it even harder to recruit new partners.
Workforce issues continued. Staff left, citing abusive patients and impossible workloads. We could not even find temporary staff to fill vacancies and had instead to rely heavily on agency locums, who come at a premium price and would not, understandably, cover all the workload. Any satisfaction we used to have at being good employers in our area was lost.
Meanwhile, secondary care and social care delays meant we were helping patients with increasingly complex conditions in the community. Our appointment numbers increased – at one site by 25% over three years.
As partners we took on yet more, spreading ourselves thinner again to cover the gaps. The number of partners in our practice halved. We all suffered burnout and ill health: two of the remaining partners needed extended time off work to recover.
By the time I went off sick, I was very unwell. I was dealing with daily panic, tearfulness and poor sleep. I had lost confidence in my abilities as a doctor, and struggled with a blurring of boundaries as I found it harder and harder to say no to additional tasks piled at my door.
As a practice, any aspiration of providing excellent care is gone. Yes, we still keep patients safe, but to the detriment of our own health. We have had to scale back, serving a smaller population from a reduced number of sites.
GP practices are not just bricks and mortar. These buildings, in the heart of every community, are propped up by the partners who run them and the staff they employ. When they can no longer hold this unbearable weight, the whole practice, and the value it offers, crumbles and falls.
We are making personal, financial, emotional and health sacrifices to keep services running for our patients and we cannot continue. We aren’t just exhausted. We are broken. And we are leaving. How can we work in a system that we feel is slowly killing us and our patients?
The writer is a partner in a small rural GP practice
In the UK, the charity Mind is available on 0300 123 3393 and Childline on 0800 1111. In the US, Mental Health America is available on 800-273-8255. In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978
