Wellbeing: Managing Workload

Guest blog by Dr Tim Horlock

Late last year I was asked to write a blog for the LMC about ‘managing workload’. I must say I didn’t know where to start. How can I teach people how to manage when I sometimes think I am barely managing myself? Not just GPs but nurses, practice managers, receptionists, the whole primary care team, as well as secondary care, 111, out of hours, the ambulance service and A&E. The entire NHS is struggling at times, not just you or me.

The problems are well known. Soaring patient demand, the influx of e-consultations, increasing work from secondary care, long waits, negative press and aggression from patients is nationwide. All faced in the continuing shadow of COVID with the continued need for PPE and isolation rooms.

At this point perhaps even the most optimistic amongst you will be realising that this is not going to be a trite guidebook on how to cope. However, I’m not going to give in to despair and neither should you. It’s not all bad, the weekly Sitrep tells us that several Somerset practices are in Opel 1 every week (Demand is being managed using usual staffing levels with staff absence level not impacting on this) and many more are in Opel 2 (Demand/staff absence is sufficiently high that additional resources – locums, extra admin staff time, etc. – have been required to manage workload). It makes me happy that some of my colleagues ARE managing. (Perhaps we should have asked one of them to write this rather than me?).

And regarding the Sitrep please continue to reply and be totally honest: it helps the LMC so much in discussions with the wider system. As an aside I always wonder if we, as doctors, know what level our practices are reporting. Why not check with your manager this week? See if you agree. 

Under the circumstances it’s normal to feel you are not always managing. We don’t need to ‘manage the workload’ we need to ‘get through this crisis in one piece’.

I think we need to be honest about that too: with ourselves; with our practices and especially with our patients. We are all doing our best, there are no more hours in the day. We are doing more consultations, with fewer doctors, than ever before. The majority of our patients understand this. For every loud, angry and depressing complaint there are hundreds of silent people who are grateful for what we do. Every now and then someone stands up and says ‘thank you’ or posts a positive review online. These small moments bring happiness to my day, they make a real difference. Why is it that we all hear negatives so much more clearly than the positives? We need to accentuate the positive more.

It doesn’t mean that we can’t change things to help. Recently at my practice we added a second on-call doctor. We had never wanted to do this as it would mean fewer routine appointments and longer routine waits. However the duty doctor dealing with over 100 patients on some days was unsustainable. And it has made a difference. It isn’t a long term solution but it is helping us get through.

On a personal level we all have to understand our limits. You will be more efficient if you actually take a break, have lunch, move around. I have a standing desk and we have some bikes that fit under the desks as well. Not just sitting for 12 hours helps me get through.

Some days you just have to say you cannot do any more. When our EMIS system automatically turns off after 12 hours I use this as a prompt to stop. The reality at that stage is that I feel I’m no longer at my best and as unpleasant as the thought is, logging on remotely the next day will be quicker, more efficient and probably safer. It is not ideal but it helps me get through.

Burnout is defined as a state of physical, emotional, and mental exhaustion caused by long term involvement in demanding situations. It is common and increasing. It is causing people to leave the profession. We are often bad at admitting when we can’t manage anymore but we can often see the signs in our colleagues. Be brave, be a friend, and if you think someone is struggling then ask them if they are OK? Allow yourself time to really listen to the answer. It may be the best thing you do all day. Earlier this year one of my partners and my manager spotted that I wasn’t coping and suggested I take some time off. It made a massive difference to me and I am forever grateful to them. It wasn’t something I could bring myself to ask for even when I knew, deep down, that it was what I really needed.

There is support out there. Everyone working in primary care in Somerset can visit Somerset Safe House which is a virtual environment with advice and support. Somerset Emotional Wellbeing is another local resource with trained psychologists available on a helpline. The popular mindfulness app ‘Headspace’ remains free to NHS staff until the end of 2022 and I am a big fan.

Make no mistake: I’m not telling you to ‘tough it out’; I’m not saying ‘you just need to work harder’; I’m not saying you should be coping.

I’m saying it IS hard, it IS the busiest I’ve ever seen it.

It ISN’T just you, it ISN’T just general practice.

This is a time to be honest, it is a time of national crisis, and we have to do our best to get through it together.

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