Last year the RCGP and the mental health charity Mind published a report which revealed that 87% of the primary care workforce – which includes general practice – experience some level of stress; this compared to 57% of the wider workforce. I spoke to Dr Asiya Yunus, GP and associate medical director at Londonwide Local Medical Committees (LMC), about the pursuit of happiness in general practice and the impact that joy and meaning can have on practice staff, as well as patient outcomes.
Relax…don’t do it
It needn’t be reiterated; general practice is under pressure – suffering from a mounting workload, bureaucracy and questions over succession and remuneration. In fact, in 2015 the national GP survey recorded the highest stress levels in practices since the survey began in 1998 – and further revealed an increase in the number of GPs intending to quit over the next five years. These data suggest that there’s a need to focus on primary care teams and give them the support they need to manage their practices and implement/lead change.
“What we found is that the core work of primary care and general practice remains meaningful and rewarding but that it’s being undermined by complex regulatory, technological, and administrative requirements,” Dr Yunus says. She points to the Time to care report – published in October 2015 – which highlighted the time spent by GPs on large volumes of clerical work in addition to their primary concern which is to manage complexity and see and treat patients. Dr Yunus terms this focus on clerical tasks ‘administrivia’ and it’s an added burden that’s having an impact on patient care as well as on how GPs feel valued.
This is the root of Dr Yunus’ desire to bring joy and meaning back to general practice. “Staff must feel valued and supported so I came up with several recommendations based on the evidence put forward in, In search of joy in practice by Dr Christine A Sinsky – published by the American Medical Association – which examined 23 high-functioning practices across the US and investigated what each has in common.” One thing that seems key is freeing-up time – or what Dr Sinsky refers to as ‘happiness minutes’ – which can lead to some joy at work.
Typically, models that seek to defeat stress and beat burnout focus on improving resilience – encouraging better sleep patterns, improved diet, etc. However, Dr Yunus believes that putting the onus on resilience, and thus on the individual, can feel punitive especially when, in general practice, the whole team is involved in the delivery of care and the whole team is over-worked and over-stretched. Resilience should be a focus, she advises, but bringing joy and meaningfulness to the work – and ensuring the whole team is involved in bringing about the change required – should take precedence.
“When we think about joy and meaning, I split it into three key areas; meaning – what matters to you, mastery – acquiring new skills and membership – effective team working,” Dr Yunus explains. It’s about the practice team having control and autonomy – and Dr Yunus references Professor Stephen Fineman saying that it’s important practice staff become architects in the make-up of what ‘good’ looks like rather than the carpenters. “When you look up the definition of burnout it’s about loss of autonomy, emotional exhaustion, low feelings of self-accomplishment. If we want to change and improve we need to be architects of systems that lead change; we need to value each other and create conditions for comradery,” Dr Yunus observes, adding that this could be something as simple as providing tea and biscuits.
Make the change
It’s about valuing your staff and making them feel like people rather than just commodities. In terms of practices whose staff are feeling taxed, and which are looking to implement change and bring joy and meaning to their working environment, Dr Yunus says there are key questions to ask. “What brings joy and meaning to your work? What gets in the way of that joy and meaning? So, first you encourage positivity and then you help them understand what the obstacles are.”
From there it’s about ironing out the issues highlighted by bringing teams together and asking ‘How can we – the whole practice team – work on changing this?’ Then you must assess whether a difference is being made; Dr Yunus suggests introducing a questionnaire that questions where the practice stands in terms of stress levels and burnout and which also asks what the challenges are – the BMA have such surveys readily available. The important thing is that a dialogue is opened up – and enabled – something Dr Yunus says is important for practice morale and also for team morale.
“Burnout impacts clinicians’ health, the organisation and patient outcomes and safety. For example, doctors who are burnt-out are less likely to report another doctor that they might be failing or might be in danger of making a mistake,” Dr Yunus says, advising that practices need to make time for their people to make time for themselves. She also suggests asking what the perfect day would look like in general practice before asking, ‘What’s stopping us from achieving that perfection?’ And that’s the thing; it’s not difficult. It may seem that, in your practice, you are wading through drudgery but there’s a powerful resource for change in every practice – and that’s the people.