Humanity in General Practice: increasing pressures in care

Insights

"Over the past 2 years, General Practice has adapted and transformed to provide healthcare in the most challenging of circumstances"

Last week NHS England announced additional support for general practice, however this support is contingent on increasing access and even greater scrutiny of General Practice. Only days before the NHSE announcement, Professor Martin Marshall, Chair of the RCGP had written about how GPs were already ‘stretched beyond endurance’ and were ‘delivering care to a growing number of patients with increasingly complex health conditions, under intense workload and workforce pressures that have only been exacerbated by the pandemic’1.

We hear every day about patient’s struggle to get appointments: GPs and General Practice teams face and respond to this need every day and act as the first point of contact for health care, providing clinical care, advice and reassurance to patients who are also living through the pandemic, which has affected us all in different, sometimes tragic ways. Over the past 2 years, General Practice has adapted and transformed to provide healthcare in the most challenging of circumstances and now our primary care colleagues are faced with the challenge to recover from the acute phase of the pandemic and prepare for the ongoing presence and impact of COVID on our healthcare system.

Workloads were already taking their toll on mental health and wellbeing, with a third of GPs saying they feel like they can’t cope at work at least once a week2. Even before the pandemic, the average GP worked less than 3 and ½ days a week because of the intensity of the working day 3 and a report this week spoke of a GP working a 70-hour week to try and meet patient’s needs4. In the face of these challenges, how can GPs and practice teams provide safe and professional healthcare and keep their humanity?

Humanity can seem like a lofty concept, one that seems far away from the day-to-day work in a busy practice, but I would argue that it is fundamental. How do we remain our best selves so that we can respond to ourselves, our colleagues and our patients with curiosity, kindness, and social and emotional intelligence? Peterson and Seligman’s research suggests that humanity is consistently considered good across all cultures and throughout history and has been shown to be positively associated with psychological and subjective wellbeing5.

Firstly, we need to take care of ourselves personally and professionally. We need to understand and support our own wellbeing: understand how we are feeling (or what Peterson and Seligman might call personal and emotional intelligence), what our priorities and limits are and what we need to not just survive but thrive. Fundamental to this is understanding what a good working life looks for us and understanding our stress responses so that we notice when we are reacting, rather than responding, and so we can support ourselves. Aligned with taking care of ourselves is having the skills and knowledge needed to take care of the business of General Practice, particularly in response to the changing demands and opportunities as they continually arise so that it too can thrive. The ability to lead and manage ourselves and the business allows us to remain responsive, involved and in positive relationship with our teams so that we can model through our own behaviour and support them to reflect on their own wellbeing, priorities, and limits, understand what a good working life looks like for them and manage their working lives so that they can in turn remain responsive as they provide care to patients.

Elizabeth Dunn, Xytal Consultant

"Over the past 2 years, General Practice has adapted and transformed to provide healthcare in the most challenging of circumstances" Elizabeth Dunn, Xytal Consultant