The awful news of the death of a GP, Dr Gail Milligan, has hit us really hard. Many of us had never heard of Dr Milligan before her death, but now her name is on all our minds. The sad state of the NHS is such that we are all broken. We often hear about GP burnout – but PM burnout is very real and is affecting many of our colleagues. I cannot tell you the number of Sunday nights I have sat and considered my future – even me, the biggest dinosaur going. I pretty much feel bulletproof most of the time, but every now and again, the work just gets to me… and I know I’m not alone in feeling like this.
As managers of teams, we constantly check on our staff: Are you OK? Do you need time off? What can I do to help you? Staff will, despite their best efforts, bring stuff from home into work, it’s human nature. And when someone needs to have a moan with you that their other half is getting on their nerves, or one of the kids is poorly again and they’re worried, or mum has cancer, or whatever it is, they offload to us because we need (and allow) them to do so. It’s absolutely vital that we give them a chance to release that pressure cooker feeling, before it spills over and potentially causes some damage.
My staff know that they are valued – I tell them often – but not so often that it becomes insincere. In the current spell of good weather, I’m going out and buying ice creams – it’s nothing really, but it can make a difference, and I know I’m not the only manager doing this. Whether it’s ‘have a cake Friday’, or just sending them thank you cards every now and again, it all adds to them feeling that we’ve got their backs.
But, who’s got ours? My partners are very good at touching base and making sure I’m OK, but I don’t know what they’d do if I said “No, I’m not.” The CEO at our LMC is always there to listen, and the pastoral services that are offered by LMCs should have a service for managers as well as GPs. We are, after all, in this together. (Check that your LMC offers this to you!)
The pressure for us is not about earning enough money to pay the bills (though that can be a factor), it’s about the amount of work we have to get through, the form filling, the hoops we have to jump through, the constant demand for data from others. I think sometimes that these other organisations (who shall remain nameless, but you know who they are), forget that we have a number of different tasks that we have to do each day – we aren’t just here to focus on the complaints return, or the workforce data set, or setting up a flu clinic. Whilst their jobs are centralised on one particular function, ours cover a myriad of things, and if I have to juggle one more ball, well I could get a job at the circus (which may be the answer to all my problems!).
So, what’s the solution? Well, the sad fact is there isn’t an easy one. There aren’t enough of us to go round. There’s no one doing my job when I take leave (God forbid that I need to go off sick), and worrying about workload while you’re away just adds to the stress, which negates the whole point of taking leave in the first place! My assistant doesn’t want my job because she sees how stressful it is and how much work I take home – and that’s not odd days, that’s most days, including weekends. If I break down, literally, who will do my job? My assistant could do some of it, but not all of it – she’s got her own work to do – and there isn’t any ‘slush’ in the workforce. At this point, people usually say “Well just employ someone else.” But you and I both know it isn’t that easy. If it was, we wouldn’t be in this position.
We need to remember that actually, despite what we might think, we are not indispensable. We can be replaced, and if we break, well, the world of primary care will still turn. Our surgeries will continue with the day to day stuff. In the background, there might be some unpaid invoices – but they’ll get sorted eventually – even if your partners have to outsource that bit of work. There might be some searches that don’t get done, a few emails left… but in the grand scheme of things, does that really matter?
I am getting better at booking more regular breaks from work, and if you’re finding that you’re working more than 10 weeks without a break, I’d suggest you sit down with a diary and book some in now! Use up ALL your annual leave – don’t carry any of it over. Can you negotiate a work from home day? Would that help? At least you might not have a commute on that day and that could make a difference. Could you negotiate doing your hours over fewer days? Is that worth considering? Is there an opportunity for a job-share? This might also give you an opportunity to do something else, outside of primary care, which would give you as much satisfaction, but not so much stress, and provide some much needed light relief.
Our other option is to take a stand on demands from those other organisations. If they email us with a deadline that feels unreasonable (and personally, I’d say anything that has a deadline of less than 10 working days is absolutely unreasonable), we should kick back. Perhaps you can chat with your colleagues and have a united front on things like this – we all need to be singing from the same hymn sheet in our own localities. Some organisations are getting better, it is true, but many are not. They need to know that they can’t just say ‘jump’ and expect us to reply ‘how high?’ I’m not asking for you to take a ‘union’ approach, but let’s be sensible about what we can and cannot achieve in our day/week.
If you feel that things are getting on top of you, it is NOT a weakness to ask for help. You are NOT a failure for asking for support. You are human. The NHS may be broken, but it does not mean that we need to break along with it. Please do NOT suffer in silence – there are a number of us here who will offer you an ear and support. You’re not alone… ever.
Nicola Davies
August 12, 2022 at 7:48 am
Hear Hear Nic!
And as for those organisations who send bulk ‘reminder’ emails to ask for information that I have already sent (but have forgotten as I did it and moved on)…I know what I would like to do to them!
August 12, 2022 at 8:34 am
My 25th year as a practice manager and I could’nt agree more, this is the worst its ever been. I have become increasingly intolerant and feel as though Im surrounded by idiots….maybe thats an age thing. I love my job but at 62 years old I have decided to go down to 2 days a week from the New Year. The staff in Primary Care are pretty much broken, thats all of us, we dont really have anything else to give. Capacity will never meet Demand, ever! The ARRS roles have not done anything to quell demand, if anything they have created a dependency. Patients need to start to take responsibility for their own health. I really dont know what the answer is but for once we need to start looking after ourselves.
August 12, 2022 at 8:39 am
Absolutely. I couldn’t have said it better.
August 12, 2022 at 8:41 am
I recognise so much of what you’ve said here Nicola. I think the demands put on PMs right now is ridiculous and there really are only so many hours in the day!! It feels like the whole of Primary Care is on its knees with little or no light at the end of a very long tunnel. I’ve had that issue of being extremely tired but not being able to sleep because my brain won’t switch off! Have I done this? Have I done that? Does anyone else know that I do this or that? I’m not surprised that some are reaching burnout and I hope to be able to see the signs of that should it rear its head, we are I feel currently trying to wade through quicksand and an unappreciative public with media driven demands doesn’t help – oh for the days of clapping and praising the NHS, long since forgotten in a fog of ever increasing expectation and a massive uplift in complaints, along with a not so massive uplift in pay given the cost of living crisis that is I’m sure affecting every member of staff especially our admin/reception staff who do a brilliant and responsible job for a less than adequate salary and are off to pastures new where there’s no aggressive patients shouting at them continuously for a rate that we cannot hope to match. Rant over, back to the oversized in tray with my climbing boots at ropes at the ready…..
August 12, 2022 at 9:18 am
Perfectly put! the workload is terrifying – my deputy who did want to progress now wouldn’t touch the job with a barge pole. I could wallpaper a housing estate with my unread or dealt with emails .
Thank goodness for the lovely PI folk to keep some small amount of cheer in the job!
August 12, 2022 at 9:41 am
I actually had a rare day off and time out last Friday – sat on the beach at 7am and had breakfast, scrolled through FB and read a post my own GP partner had shared – it was Dr Milligan’s husbands words and it struck a cord – it mirrored what my GPs are going through and if they are, we know all PMs, their assistants and their teams are too – it saddened me deeply and I sat in the sun and cried.
I work alongside a strong and supportive team, I am a dinosaur like Nicola, I am resilient, I look after myself and I am upbeat and love what I do (still) BUT everything Nicola has said is true.
You have to look after yourself before you can look after others so this weekend turn off that phone, get outside in the shade/sun with your family, splash around in some water or go to the pub with your friends and have a glass of something long and cold – laugh, eat and rest.
My PM is leaving us – reached the point of no return – she doesn’t want to leave the team or the practice but she wants to leave the job – sad but true so I know first hand how hard it is. So if you fancy a move to Cornwall – drop me a line! We have the best team and a great PCN – I promise to keep you well too!
Thanks Nicola – I met with a new PM this week at another surgery, new to role, very new to Practice Management completely, I asked if she was nuts taking it on – she said NO she was really starting to get on – she also said she had an amazing mentor – wonder who that could be????? Mrs Davies – you may think you are a dinosaur but you are shaping the future PMs of this world – long may you roam the wilds of Cornwall!
August 12, 2022 at 9:48 am
Quite so Nic!
What is galling me in particular at the moment is the emphasis on “Wellness” training and apps to support our burnt-out teams to cope with the toppling Jenga that is today’s NHS. As if it’s not a problem with the NHS but our problem in not being able to cope with everything that’s being hurled at us. Sticking plaster on a gaping wound.
August 12, 2022 at 9:57 am
Another wonderful piece, articulating the heartfelt, the challenging and the pragmatic you balance each day. You do the impossible – you do it so often that it becomes the normal impossible. general practice is indebted to its Practice teams, and the wonderful managers who work alongside them.
Whatever would general practice do without you all? Let’s hope that we never have to find out.
August 12, 2022 at 10:17 am
Definitely! I can relate to all of what you have written. I question my job most days and not sure I can take anymore stress. I agree, I look after all staff including partners, but no-one looks after me. My staff are brilliant, but feel once they have off-loaded their work problem, their stress then becomes my stress and they no longer need to worry. EMAILS!!!!!! I spend so much of my time answering emails 24/7. Anyway, back to my wonderful job.
August 12, 2022 at 10:46 am
Very well said Nic
Your right the NHS is broken and NO we DONT have to break with it, this is what i am going to keep telling myself.
This has been the toughest job I have ever endured, unfortunately no one will know how tough unless they have a go at it themselves.
Practice Manager, Business Manager, whatever Manager, in Primary Care the title doesn’t cut it at all.
Great article
Thank you x
August 12, 2022 at 11:03 am
Hit the nail on the head with that one Nic. Very emotive piece and totally identifiable.
August 12, 2022 at 11:30 am
I totally agree! It is really hard to manage patient expectation and having all the ARRs roles seems to have created work not relieved it. Yesterday an ambulance dropped a patient off as in the word of the paramedic “the patient isn’t poorly enough to go to hospital” so they dropped the patient at the practice and the GP then had to spend an hour with this mental health patient whilst the rest of her booked clinic waited to be seen. I too am in my early sixties and still love my role after nearly 20 years but it is getting more and more difficult to juggle all the requirements. I missed an item of the partners meeting agenda and was told by the GP they were disappointed in me for not remembering, because I am always “on it” so we often become victim of our own success. I must admit this was the thing that brought a tear to my eye. I agree with Nicola about taking a break, I have a long weekend about every 6 weeks as well as my 2 week holiday and trust me I never do any work when I’m off any more. I work more than hours every week whilst I am in the office and with 3 horses , a dog and cat all needing attention I rarely take work home and they provide proper downtime and a release from the day. Remember to take care of yourself as they will always manage when you are not there.
August 12, 2022 at 12:49 pm
Since I started in this job 10 years ago GPs and PMs have continually told everyone what a hard, thankless, impossible stressful job they are doing.
I have for the most part thought that the job of Practice Manager is a wonderful job and I have been privileged to have been given the opportunity to be able to do it for so many years.
It isn’t the job, in my opinion it is the constant addition of layers of management that make the job so hard to do.
While I am still optimistic about the future I have decided that this job is no longer for me. I dont want to worry about the systematic destruction of the NHS any longer.
I wish you all luck, but remember… it is just a job, you can always just get another one!!! There isnt anything you cant do if you put your mind to it
August 12, 2022 at 2:04 pm
Thank you Nicola. So eloquently put and so very true. Being a PM can be a hard, thankless, stressful, and at times, impossible job.
August 12, 2022 at 7:46 pm
Beautifully written piece, Nic, and all so true.
I have a particular bug bear about other people/organisations imposing their deadlines on us, just because it suits them, and totally agree that we need to avoid dancing to their tune.
August 12, 2022 at 10:09 pm
Thanks everyone for your very positive feedback. Remember it is only a job at the end of the day (but saying this after not leaving till 6.30 because of some secondary care offload – but that’s a rant for another day!!)
Stay safe, stay sane!
August 17, 2022 at 10:46 am
Thanks for writing this article Nicola.
I too consider myself as a dinosaur having spent 35 years in primary care in different roles but the last 3 months have really taken the toll. In fact often I’m so tired I could cry and try very hard not to, at least in public.
I am very capable of saying ‘no’ and my delegation skills are good.
I’ve got 2 weeks off next month, my worry is coming back to face the backlog.
Now I know I’m not alone.
August 22, 2022 at 7:25 pm
We absolutely all agree with this but the one thing that CCGs staff go on about is “take care of yourself” and by the way here is an urgent piece of work that has a zero days notice and we want the information now. Not sure they really are on the same page. Still dosing the pressure on us in one hand and being kind in words in the other!!!! Maybe we should actually say next time, not enough notice, will do it but it will take a week. Se how that goes down.