The role of GP's in times of austerity

Austerity is changing the nature of general practice, both in terms of the conditions that patients present with and the resources at a general practitioner’s disposal that can be brought to bear on the increasing patient demand.  This changing face of general practice coupled with an increasing non-clinical workload has placed considerable pressure on individual GPs, leading to absenteeism (when doctors miss work because they are unwell), presenteeism (when doctors work despite being unwell) and loss from the profession (for example through early retirement, reduced clinical work or moving overseas). Drawing on our NIHR-funded Care Under Pressure project, I will provide some insights into the ways in which doctor’s mental ill-health may develop, and the strategies that are likely to help prevent or alleviate the problems.  In particular, I will explore the role that undergraduate and postgraduate medical education can play in supporting GPs working under challenging conditions.

As GPs, we need to be mindful that our patients’ distress and suffering is not necessarily rooted in individual psychopathology, but may have significant external causes.   We should avoid using a diagnosis of depression or anxiety as a mechanism of decoupling, replacing adversity with illness and individualising primarily social problems. We must remember that, in our consulting rooms as in our lives, the personal may be political. When we come to offer help, that too needs to take account of the socio-political domain.  Our psychological solutions must be oriented towards empowering patients living in communities exposed to adversity.   And we must make the opportunity to develop effective partnerships with our local communities, actively linking with a wide range of local resources. In addressing the challenge of austerity, primary care is necessary but not sufficient. GPs are in a (not the) position of authority within the community.  We need to de-centre and re-connect.