Health and Wellbeing for Practice Staff (not GPs)
Support for the Team
- Bereavement Support Line
- Locum Support for the Practice Team
- Looking After you Too
- Looking After Your Team
- Looking After your Career – Coaching Opportunity
- Mental Health at Work
- Mental Health and Wellbeing Hubs
- Self-Care and Stress Management
- Support for GPs
- Support for Practice Nurses
- Support for Practice Managers
- Practice Manager Supporters
We live and work in difficult times. The NHS is facing unprecedented challenges as it struggles to meet increasing demands and expectations.
Life in the practice is also increasingly challenging. The working day seems to get longer and longer with ever more tasks and pressures.
At Wessex LMCs we are increasingly aware of the effect that all this is having. We are seeing more GPs with stress related problems, more with performance issues and more partnerships, practices and managers getting into difficulties.
This page looks at stress in the whole practice team and what resources are available for support and advice.
There is a specific page for GPs – GP Support Health and Wellbeing, which looks in more depth at particular circumstances and help for GPs.
Caution. . .!!
This information is not an alternative to professional help. If you feel, when you have looked at some of the resources here, that your issues go beyond self-help then you should seek help. Go to see your GP, use the confidential help lines, and try to talk to your colleagues, family or friends openly about how you feel. Try to create some time for yourself and protect that time. You need time to think. These steps are not easy to take but are essential if you wish to make a positive change and start enjoying your life more.
“Stress is a condition or feeling experienced when a person perceives that their demands exceed the personal and social resources the individual is able to mobilize”. In short, it’s what we feel when we think we have lost control of events. The key concept here, is that it is an emotional and physical response to a thought process, and that other factors influence how we respond to demands placed upon us.
Some of the common features of stress:
- Difficulty getting to sleep or difficulty waking up in the morning;
- Constant fatigue;
- Aches and pains for no apparent reason;
- Poor appetite;
- Social withdrawal;
- Loss of interest in activities;
- Increased anxiety and irritability;
- “Flying off the handle”;
- Palpitations and raised blood pressure;
Here is a great little video by a Canadian doctor. It highlights the problems and brings out some of the key concepts in stress management. “The Single Most Important Thing You Can Do for Stress”
Please take some time to watch the video, reflect on it and then watch it again!
The key points are that you can change your thinking style and how you react to the situations you find yourself in. But you might need to learn techniques to do this and new skills to break away from patterns of established thinking and behaviour.
Remember, if you can’t change the situation (too many patients, too much paperwork, not enough time etc.) then you can change how you respond to it.
Here are some resources for stress management:
- How to be happy is a video looking at some resilience and stress management tips. Website: https://www.youtube.com/watch?v=sycZZrYvCNw
- Mind Tools is an interesting site that has lots of useful material. A lot is open access and contains material on stress management, project management, communication skills etc. You can find these in the toolkit section on the website. Website: https://www.mindtools.com/
- Top Tips for Stress Busting Presentation – Contains links to the videos ‘Signs and Symptom of Stress’ and ‘Stress Management Techniques’. Website: Wessex LMCs Stress Presentation
Try thinking in Terms of Resilience Rather than Stress Management. Increasingly experts in the field are turning to alternative views of traditional stress management and exploring how people can increase resilience to stress rather than trying to remove it or manage it.
Resilience vs. Traditional Stress Management
Resilience: Focus is on a solution Stress Management: Focus is on a problem
Resilience: Addresses personal strengths Stress Management: Addresses symptoms and deficits
Resilience: Stress viewed as normal and inevitable Stress Management: Stress viewed as pathological and destructive
Resilience: Problems are opportunities for growth Stress Management: Problems are an indication of failure
Resilience: Optimism and hope are the cause of success Stress Management: Optimism and hope are the result of success
Resilience: Happiness is the goal Stress Management: Coping is the goal
If the constant stress of work and life is leaving you feeling disillusioned, helpless and worn out then you may be suffering from burnout.
Burnout is a state of emotional, mental and physical exhaustion caused by excessive demands and prolonged stress. It leaves you feeling increasingly helpless, hopeless, cynical and resentful. Life loses its meaning and you may feel you have nothing left to give.
Here are some common signs that you might be experiencing burnout:
- Exhaustion mental, physical or emotional, or all three;
- Neglecting your needs no time or energy for anything else other than work;
- Lack of motivation don’t feel enthusiastic about anything anymore;
- Frustration, cynicism or other negative emotions these become overwhelming;
- Slipping job performance tasks building up, complaints increasing;
- Interpersonal problems at home and at work more conflicts, withdraw from colleagues and isolate yourself;
- Not taking care of yourself develop unhealthy coping strategies drinking more alcohol, eating too much, junk food, smoking more, having affairs, self-medication;
- Being pre-occupied with work, even when not at work;
- Generally decreased satisfaction in everything you do;
- Health problems digestive issues, heart disease, depression;
- Depersonalisation, lose contact with yourself, no longer see yourself as valuable and lose track of personal needs. Your view of life narrows to the present time and life turns to a series of mechanical functions or tasks that are not to be enjoyed but just completed.
Stages of Burnout
There are several different models but the stages are similar:
High energy, good satisfaction from trying to solve problems and make changes, you find the job interesting most of the time
Fuel starting to run low
- Gradual onset of frustration, tiredness and loss of interest. Distancing yourself from colleagues and patients, become more cynical
- Denial of emerging problems blame increasing problems on time pressure and all the work you have to do
- More mistakes
- Physical symptoms increase fatigue, sleep disturbances
- Escape activities such as drinking or eating too much, smoking, buying things
Towards a crisis
- Symptoms and dissatisfaction with the job dominate all areas of life
- Wanting to be alone, rejecting help, lots of anger and inability to relax
- You start thinking of extreme measures to escape – moving, resigning, divorce or even suicide
- Energy is very depleted and symptoms get worse
It is often the best people that burnout, because they invest the most energy, emotion and commitment to their work, but at the expense of themselves. If you are a hard working idealist or a perfectionist your risk is even greater.
Causes of Burnout
There are many causes of burnout, in many cases it stems from your job but can result from any situation where you feel overworked and undervalued. This may be a combination of work and home life. Other factors also contribute to risk of burnout, including lifestyle and personality traits.
Work related causes
- Feeling like you have little or no control over your work
- Lack of recognition or rewards for good work
- Unclear or overly demanding job expectations
- Doing work that is monotonous or unchallenging
- Working in a chaotic or high-pressure environment
- Working too much, without time for relaxing or socialising
- Being expected to be too much to too many people
- Taking on too many responsibilities without help from others
- Not getting enough sleep
- Lack of close or supportive relationships
- Perfectionist tendencies, nothing is ever good enough
- Pessimistic view of yourself and the world
- The need to be in control, reluctance to delegate
- High achieving type A personality
There are lots of tips, books, websites out there with plenty of advice. Most involve some of the following and spending some time reflecting on how you can avoid burnout is never wasted, even if after reading the above you don’t feel it applies to you.
- Give yourself planned time for a relaxing ritual. This might be doing gentle stretches, meditating, writing a journal, reading, listening to music etc. The key is to do it mindfully, with your whole attention.
- Eat healthily, exercise and get enough sleep
- Set boundaries
- Take a daily break from technology, “disconnect from an overly connected world”
- Do something creative and chose activities that have nothing to do with work or achievement
- Learn how to manage stress you may need help with this
Recovering from burnout
If it’s too late, and after reading this it is clear to you that you need help, then you need to take your burnout very seriously. You can’t push through burnout and serious harm may come to you and your family if you do.
SLOW DOWN. You need to force yourself to slow down or take a break. Give yourself time to rest, reflect and heal.
GET SUPPORT. You need help. Share your true feelings, stop trying to deny the situation and talk to another person. Consider seeing your GP and perhaps book a double appointment.
RE-EVALUATE. Burnout is a sign that something isn’t working in your life. Your task is to find out what and put it right. You may need help to do this.
TAKE TIME OFF. If burnout seems inevitable then you might need to take a complete break from work. Take a holiday, ask for leave of absence, take a sabbatical or you might need to take sick leave. Unless you take a break you will not be able to find the solutions.
It is really important to put fears and inhibitions to one side and trust the professional judgements and decisions of others. The strong person is the one who recognises the problems and decides to take action positively to get a better life.
There are implications of stress and burnout for individuals, however there is a responsibility for the practice to manage stress caused by or made worse by work.
Workplace factors that can cause stress can be broken down into those to do with the content of work and those to do with the social and organisational context of work.
Sources of Stress at Work
- Intrinsic to the job
- Role in the organisation
- Career development
- Relationships at work
- Organisational structure and climate
- Home-work interface
Think about the practice and how some of these sources of stress are affecting the clinical and/or non-clinical staff.
In general practice at the moment then the obvious risk factors in this category are
- Time pressures and deadlines
- Work overload
These hazards apply across the organisation and all members of staff are exposed – who might be most at risk in the practice?
Role in the Organisation
This source of stress usually comes from either having too much or not enough responsibility within the organisation, role conflict or ambiguity and lack of management support. A classic example in general practice would be the practice manager who is constantly undermined by the partners.
This stress risk is usually linked to under or over promotion, thwarted ambition and threat of job losses.
In the uncertain times we now find ourselves we should acknowledge the uncertainty that this brings and that some people will find this very stressful.
Relationships at Work
This relates to relationships across the organisation with your boss, colleagues or subordinates. Obviously personality clashes are common but difficulty in delegating responsibility is another common issue.
Think about the relationships in your practice. Which ones might you be able to predict might cause stress?
Organisational Structure and Climate
This relates to the “feel” of a practice. When we visit practices it is amazing at how quickly you can get a sense of how that practice works and what it might be like to work there.
Office politics are inevitable but how are they managed? What participation in decision making do staff actually have and how do the management consultant and communicate? Lack of consultation is cited as a cause of about half of the cases of occupational stress.
Think about how your practice might feel to an outsider? Is it a happy place to work? Are your staff truly engaged in the business of making your practice successful?
This relates to issues covered in the first sections on stress and burnout. General practice is a demanding job for doctors and for managers and the demands can cause conflict of loyalties between work and home. Also, problems outside of work can affect performance in work that leads to stress in the workplace.
How good are your boundaries between work and home? How can you strengthen them?
Hopefully this will have given you some food for thought and some ideas may be developing as to what you might be able to do to help yourself and the staff at your surgery manage stress across your organisation. It is worth considering briefly the legal position on stress in the work place and the responsibilities that employers have to manage stress.
Stress at Work and the Law
Employers have duties towards the health and safety of their staff. These are either:
These fall under the Health and Safety at Work Act (HSWA) 1974 and the Management of Health and Safety at Work Regulations (MHSWR) 1999. These are regulated by the Health and Safety Executive (HSE) and Local Authorities (LA).
The HSE have stated that ill health resulting from stress caused by work must be treated as the same as ill health due to other physical causes present in the workplace. This is important as it clearly sets out that employers have a responsibility to manage or at least attempt to manage stress in the workplace.
Under the management regulations an employer must:
- Proactively identify causes of stress in the workplace
- Undertake a risk assessment
- Implement control measures which prevent or control the risk of physical or mental harm
However the duties are limited and will be considered in terms of:
- Degree of control
- Reasonable practicability i.e. what might be reasonable within the resources of the practice
The burden of proof for criminal conviction is “beyond reasonable doubt” so prosecution is harder to secure than civil claims.
To date there have been no prosecutions under health and safety law relating to work related stress.
This relates to civil cases brought by individuals under the tort of negligence. The individual must prove that they were owed a duty of care by the person or organisation they are suing and that any injuries or harm were the direct consequence of a failure to take reasonable care. The burden of proof is “in the balance of probabilities”, i.e. lower than criminal convictions.
The key issues are the extent to which the harm was foreseeable and what steps has an employer taken to control the risk of harm.
Case law has established that employers have a duty of care to an employee’s mental as well as physical health.
One difficulty in managing stress from an employer’s perspective is deciding what assumptions can you make about an employee’s resilience, mental toughness and stability of character, given that people of clinically normal personality may have widely differing ability to absorb work related stress?
A recent decision in the House of Lords was that it did not matter if the employee was not of normal “fortitude”. The employer must take the employee as he finds him. This may imply that employers need to be especially active in managing stress as they may be subject to a negligence claim even if the individual was especially vulnerable to stress.
What Actions can a Practice Take?
Given the brief explanation of the legal position it seems that all practices should consider how they manage stress in the practice. This means more than writing a stress management policy that sits on a shelf gathering dust!
Step 1 – You need to find out what the common stress triggers are in the practice. This may be different for different members of the team e.g. what stresses a receptionist may be very different to the senior partner or the practice manager.
A team meeting, either as the whole practice or by role in larger practices, would be a good way of finding out. Get a flip chart and brain storm. Encourage honesty and you be surprised by what you find out. When you have a list try to classify them into the six classes of stress we discussed at the start of this article.
Step 2 – You now need to risk assess each stressor. This means thinking about if the stress situation is a high risk of causing harm either because of scale or frequency. Do you have evidence that this might have caused harm in the past? Look at sickness absence records. Can you see any patterns that might indicate stress related behaviour e.g. higher absence amongst reception staff on very busy days etc.
The likely top categories will be time pressures and deadlines, work overload, lack of control over work, poor social support and feeling isolated and relationship issues. But it’s really important that you try to find out what causes stress in your organisation.
Step 3 – Next is putting a control measure in place. Remember this can be proportional to the resources available. So, for example, if a member of staff identifies not being able to park their car near the surgery is a major stress factor then you will not be expected to build a new car park but you might be able to look at car share schemes or adjusting the employees working times to allow her time to drop her children at school and get to work without rushing if she can’t park nearby.
So it is important to think about what causes the stress in your practice, how much impact that stress is having on your staff and what control measures can be put in place to reduce the risk of harm.
Credit: This article is based on a Thor-GP learning module. Thor-GP is the national reporting system of occupational diseases by doctors with training in occupational health based at the University of Manchester
GP Support and Practice Manager Support
A core part of the role of Wessex LMCs is pastoral support.
The LMC offers one to one support for GPs and Practice Managers. Like everyone they might face a range of situations from both challenges in the practice to those in the rest of life. The LMC aims to support and develop individuals as they progress through their careers.
GP Support is a confidential support service set up by Wessex LMCs and is targeted at helping GPs improve the way they deal with the common issues that many face.
For practice manager support including coaching, mentoring and appraisals please see our dedicated page: Practice Manager Support