A burned out, under-resourced workforce

A new year beckons. What will it mean for our benighted health system? Not much, is the short answer, especially for those working in primary care.

Amidst the hype surrounding the HSE’s 2019 National Service Plan (NSP), a little noticed statistic confirmed our suspicions. With just €4.5 million – a 0.5 per cent increase – allocated for new developments in primary care this year, the NSP fails to support the widely accepted need to build up primary care infrastructure. The perennial ‘Cinderella’ status of general practice continues with primary care’s minuscule share of overall health spend set to continue. Indeed as a share of the HSE budget, primary care is falling from 6.9 per cent to 6.6 per cent.

So for the many nurses, doctors, practice managers and receptionists, whose working day more often than not resembles a war zone, there is no sign of the siege lifting. Which in turn will mean more early retirements and an ongoing difficulty getting newly trained GPs to commit to a career in the specialty.

Stress and burnout are now a major occupational health risk for those at the primary care coalface. The most recent measure of burnout in general practice comes from a Medscape survey of doctors in the UK.

Almost a third of respondents reported feeling burned out at some stage, while some 14 per cent said they were depressed (compared with 3.3 per cent prevalence in the general population). Of these a quarter had been diagnosed with clinical depression. Work was the main cause of doctors’ depression; not surprisingly, this is having a negative effect on relationships with patients and colleagues.

Of those doctors reporting burnout or depression most do not seek help, even when workplace schemes are available. And of those who have experienced burnout 37 per cent have considered leaving medicine altogether.

Asked what factors would help reduce burnout, doctors cited reduced patient loads, more manageable hours, and gaining more respect from managers and staff.

The results reflect research published by the UK Society of Occupational Medicine last October. It found that doctors are at greater risk of burnout, stress, and mental health issues than the general public.

Commenting on the Medscape survey, Prof Helen Stokes-Lampard, Chair of the Royal College of General Practitioners said: “GPs are under unprecedented pressures and we are working harder than ever, often putting in 12-hour days in clinic and on some days having to make more than 100 patient contacts to cope with the workload. Unfortunately, it’s no surprise to hear that a high proportion of our colleagues are struggling with stress and burnout.”

She noted that general practice workload has increased by at least 16 per cent over the last seven years, both in volume and complexity. And exactly mirroring the experience here (albeit from a higher starting point) the share of the NHS budget GP receives is less than it was a decade ago.

“There comes a point beyond which we can no longer guarantee safe patient care and much more needs to be done to solve the root cause of the workload and resource pressures primary care teams are dealing with,” Stokes-Lampard added.

Asked specifically about the effects of clinical depression on patient care, one half of respondents said it did not lead to patient safety issues. But of the other 50 per cent, being less engaged and more irritable in consultations was the main impact. However, some 14 per cent of those who are depressed said it made it more likely they would make mistakes.

Of those who experienced burnout most said it lasted 12 months or more. Individual responses show how much burnout affects home and professional life. As well as early retirement, some doctors change specialty or move to a different geographic area in response to burnout.

There is no reason to believe the results would be any different in Ireland. And it shows the need for confidential, non-judgmental, local, easily accessible care to be made available to all staff working within a medical environment. Services should at least mirror those available to our patients.

Robust primary and community care is seen as playing an essential role in enhancing health outcomes. A strong primary and community care system will be invaluable for preventing the development of conditions that could ultimately require acute hospital care. Sadly the 2019 NSP neither advances this agenda or offers respite to highly stressed groups of health professionals.

Be aware of burnout this year and mind yourselves.