PM burnout
April changes as one of the main causes of stress at present. “Levels of stress are rising and it is becoming harder to manage the day-to-day pressures than it was,” he says. “Managing staff gets harder as more and more staff appear to be having time off sick, which takes a lot of time to manage. It doesn’t help that all staff are working under a lot of pressure all of the time.” One practice manger, who wished to stay anonymous, says that she is finding it a “battle to survive”. “There is so much bureaucracy, paperwork and audits to complete in ever tighter deadlines, all for less income,” she says. “We are working longer hours in order to meet these deadlines but for less ‘reward’. We increasingly have to review staff roles, hours and salaries along with all of the other overheads in order to reduce costs and maximise income.” Indeed, bureaucracy was mentioned by a number of practice managers who agree that it is one of the key contributors to stress and possible burnout. “This year has been awful,” says Stephen Humphreys, practice manager at The Garden City Practice. “CQC has been the main problem, but the introduction of so many other changes, such as the shift from PCTs to CCGs, new enhanced services and CQRS, which are mostly not in a ready state, has contributed to increased stress and workloads.”
KEEPING PATIENTS HAPPY On top of this, practice managers are increasingly finding that patients are expecting more from their practices than ever before. “Demand from patients is ever-growing and practice managers have to face more dissatisfaction from patients,” says Moyse. “They often feel isolated from partners who increasingly keep their heads down rather than being willing to help.” Indeed, practice managers are often found
walking a relationship tightrope between the practice partner and the rest of their staff. There is the question of ‘managing upwards’, due to the fact that they are employed by the doctors to supervise the doctors. Dr Michael Peters, medical director of the BMA Doctors for Doctors unit, thinks this puts practice managers in a bit of an ‘invidious situation’. “It is really important that practice managers have adequate support from their staff and people around them, as well as insuring they make space for themselves and don’t let things fester,” he advises. However, it is not all doom and gloom. Annette Given, practice manager at The
48 october 2013
Spa Surgery, says that she isn’t aware of any practice managers who have suffered burnout. “I’m lucky to have a good team around me and GPs who are switched on enough to be involved and who appreciate the need for time for strategic planning,” she says. “However, I certainly think that the job is stressful, and the major changes in the NHS, particularly the demise of the PCT, has caused a great deal of extra work within practices.” This is definitely important. Insuring that all of your practice staff is on board with decisions is certainly one way to ease the pressures hanging over the team.
TACKLING THE PROBLEM
There are no straightforward answers to solving stress and burnout, but the solution should involve a combination of preventative measures, such as changes to the work environment and management systems, with programmes set up to manage burnout in those who already experience it or are thought to be at high risk. Roger Crabtree, who is involved in a
GP ‘safehouse’ programme in Somerset – an online support service for practitioners experiencing professional challenges – says that stressed individuals often find it hard to see a way out of problems that are presented to them on a daily basis. However, he notes that managers are much less reluctant than GPs to admit that there is a problem, which is a good thing. He says that timekeeping is something that often needs addressing; a practice manager who can’t say no to anything will eventually have timekeeping problems and this will inevitably lead to stress. He adds that talking to someone as soon as the problem becomes apparent is the first step to reducing the risk of burnout. Tushar Shah, interim practice manager
at West Hampstead Medical Centre, points out that many surgeries now have assistant practice managers to help out in increased administration work relating to targets and achievements: “There’s simply not enough time for a practice manager to take in the many changes, including legislation, under the recent NHS reforms.” This could be one way to reduce the increasing pressures being laid down on practice managers in the UK. If you suspect you are suffering from stress or burnout it is important that you identify the problem, understand that you are not alone and talk to someone about it. It’s never too late to put the fire out.
Warning signs and symptoms of burnout
Physical signs and symptoms • Feeling tired and drained • Lowered immunity • Frequent headaches, back pain and muscle aches
• Change in appetite or sleep habits
Behavioural signs and symptoms • Withdrawing from responsibilities • Isolating yourself from others • Procrastinating • Using food/drugs/alcohol to cope • Taking out your frustration on others • Skipping work, coming in late or leaving early
Emotional signs and symptoms • Sense of failure and self-doubt • Feeling helpless, trapped and defeated • Detachment • Loss of motivation • Increasingly cynical and negative outlook
• Decreased satisfaction and sense of accomplishment
work/life
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