Author Archives: Johanna Spiers

Johanna Spiers

About Johanna Spiers

Johanna Spiers is a qualitative health researcher working at the University of Bristol. She uses a range of methods to investigate different health psychology topics. Her current work explores the experiences of GPs who are in need of support.

GP partnerships – sinking into obscurity or sailing into the future?

Johanna Spiers

Johanna Spiers

Johanna Spiers is a qualitative health researcher working at the University of Bristol. She uses a range of methods to investigate different health psychology topics. Her current work explores the experiences of GPs who are in need of support.
Johanna Spiers

vmrmyolqzwo-andreas-ronningenThis post was co-authored with Ruth Riley. Ruth is a medical sociologist and qualitative health researcher with an interest in the mental health and wellbeing of NHS healthcare professionals. She is Principal Investigator of a NIHR SPCR funded study: Exploring the barriers and facilitators to help-seeking amongst GPs: Improving Access to Support.

In the past, the huge majority of GPs were partners, with partnership seen as the obvious career pathway. Partnerships consist of groups of general practitioners who own and run their practices, meaning they are in some regards their own bosses. However, the numbers of salaried GPs (employed by the partners) and locum doctors have been soaring in recent years. Many younger doctors and GP students are now deterred from seeking partnerships, seeing them as unattractive or even risky.

As a researcher looking into the mental wellbeing of GPs, I have found myself inclined to agree. I have spent the past 12 months of my working life interviewing distressed and anxious GPs who are working in a context of increasing workloads and financial pressures, and analysing those interviews. So many of those GPs have spoken to me and the project’s PI Ruth Riley about the difficulties of partnerships that it’s been hard to see what the advantages might be.

When more and more partners resign, it can become a sickening game of tag to find out who is the last doc standing.

It won’t be news to any readers of this blog that there is a recruitment crisis in general practice. GPs are retiring, resigning and relocating in droves, meaning those remaining are hideously, heart-breakingly overworked. And they don’t have the option to leave at the end of their shift and sign the work over to the next doctor; a GP partner’s shift starts and ends with her or him.

Being small business owners, GP partners are financially responsible for their practices, meaning that when more and more partners resign, it can become a sickening game of tag to find out who is the last doc standing – and who is therefore personally responsible for the masses of debt a forsaken GP practice will have built up.

GP partners are also expected to act as managers, running the books, organising human resources for staff members and disciplining wayward employees. Medical school doesn’t currently offer much in the way of management training (although there is a move towards introducing this), meaning these roles can be extremely stressful for GPs and are sometimes very badly handled, resulting in stress for the whole practice.

Add to this a total absence of formal occupational health protection during periods of ill health, no guaranteed maternity leave and having to juggle the potentially fragile and fraying egos of your colleagues every week in a partnership meeting, and it becomes resoundingly clear why partnership feels like a poisoned chalice to so many.

To counter this gloomy picture, I have heard some arguments in favour of the partnership model. Some of the doctors I interviewed spoke glowingly of the team work, trust and mutual support within their partnerships. One participant in particular worked at a surgery which is a shining example of good practice, with all members chipping in to fund a therapist to come in twice a month and provide supervision. If more partnerships were able to run this way, how much better could things be?

A recent debate (2016) in the BMJ argued that maintaining semi-autonomous employment will save GPs from a similar stand off to the one in which the junior doctors continue to find themselves. However, I wonder if this is true? The department of health and the NHS seem entirely capable of imposing changes and demands on GPs within the current model, so I find this doubtful.

The partnership model works well for some; merged super-practices with all salaried GPs may be best for others.

There is no one model which will suit all doctors; and there is no one way of working which will suit every team of doctors. Some partnerships are small and supportive, some are large and lonely. And the reverse can also be true. The dynamics of each group will depend on so many factors: the personalities of the doctors involved, their experience, the socio-economic status of the area and much more besides. The partnership model works well for some; merged super-practices with all salaried GPs may be best for others. This is a complex debate and there is no easy answer.

However, there is one thing which would help towards solving these problems, and that’s a genuine increase in funding to general practice from the government. More money could mean more doctors, more capable managers, more training and more occupational health support, all of which could make the partnership model more sustainable, or allow thinking space for a viable alternative. The GP Forward View promises this cash, but will it arrive in time? Critics have said the promised money isn’t in addition to existing funds, but is just rebranded existing funds. Without that extra money, the future of GP partnerships seems in danger of sinking.

References

Majeed, A. & Buckman, L. (2016). Should all GPs become NHS employees? BMJ. 355:i5064

 

 

 

How research is helping with GP wellbeing and informing performance at Feel It Festival

Johanna Spiers

Johanna Spiers

Johanna Spiers is a qualitative health researcher working at the University of Bristol. She uses a range of methods to investigate different health psychology topics. Her current work explores the experiences of GPs who are in need of support.
Johanna Spiers

file0001634469948GPs work back-breaking hours, often in isolation. They make hundreds of decisions every day, sometimes without time to eat, drink or breathe. The fear of making a mistake or receiving a complaint is ever present.  GPs feel constantly under threat, overly scrutinised, under pressure, disillusioned, demoralised by the battering they receive at the hands of the press. Many GPs love their jobs, yet find themselves crumbling in the face of ever increasing workloads, a constantly changing system which seems almost designed to trip them up, and the pressure of running a small business with ever decreasing funds.

I am a qualitative health psychologist based at the University of Bristol. Our team (from Bristol, UCL, Keele and the Practitioner Health Programme) are conducting a qualitative study exploring the experiences of GPs living with depression, anxiety, stress and/or burnout. We are hoping that our findings will help define the barriers and facilitators to help seeking for this group, as well as illuminating participants’ experiences of mental illness in a resonant manner.

Our analysis is ongoing, and of course we hope to publish our findings in several high impact journals. However, we wanted to communicate our research findings to a wider audience and engage the public with this topic area using a more dynamic and creative approach.

In collaboration with The Elizabeth Blackwell Institute at the University of Bristol, the study team have commissioned Viv Gordon, an innovative and talented dance artist with lived experience of mental illness to communicate the findings of our study. Viv has used anonymised transcripts as a source material to create a performance piece called Pre Scribed (a life written for me), which will be performed at the opening night of the Feel It Festival (http://www.bristol.ac.uk/blackwell/public-engagement/feel-it/).  Having seen a preview of the script, Ruth Riley, the Principal Investigator of the study, said that “Viv has crafted a sensitive and imaginative tragi-comic performance piece based on a doctor’s life script while examining and engaging with some of the paradoxes of being a doctor-patient.  This is an unforgettable, emotive and hard-hitting piece, not to be missed.”

Viv says of the experience:

The research transcripts offer such rich stories, such important stories, that it feels a great privilege and also a great responsibility to translate them into a performance that captures the complexity of the GP experience. The challenge for me is to offer something that illuminates the research without telling the audience what to think or how to feel but instead raises questions, curiosity and dialogue. My own experience of having what I call a “high functioning breakdown” a few years ago is helping me connect with the internal tug of war that goes on for people who are genuinely doing their very best under unmanageable circumstances. It’s important to me that I’m coming at the subject with that personal understanding and I hope that can add weight and authenticity to the performance work.

As an academic, it can be discouraging to feel that no matter how important and insightful the findings of a research project may be, they are likely to have a pretty limited audience. Most researchers will talk about wanting to do work that makes the mystical and revered ‘Real Life Difference’, but the reality can often be more about inciting the same half dozen people one sees at every conference to a lukewarm discussion before heading off to the buffet. It is therefore really refreshing to see our findings turned into something with genuine emotional power, and the potential to reach a diverse audience.

I would love to feel that our work had the potential to influence governmental policies on support for GPs, and who knows, maybe it does. What I am sure of, though, is that Viv’s piece will engage members of the public, who may then approach their GPs with more empathy, and read their Red Tops with more skepticism. And of that, I feel truly proud.