A guiding hand in a time of stress

Independent Practitioner Today’s joint survey with the MDU last month revealed worsening stress and anxiety levels among a high proportion of doctors in private practice.

Dr Udvitha Nandasoma outlines some of the support available and urges consultants and GPs to seek help if they are struggling.

In contrast to the busy and sometimes frenetic environment of an NHS hospital, the world of private healthcare may have the public perception of a serene and controlled environment.

And yet it would be a mistake to think that working in the private healthcare sector is a stress-free experience. 

According to a survey of independent practitioners by the Medical Defence Union (MDU) and Independent Practitioner Today – see ‘Covid has altered private practice’ – over half (55%) of people working in independent practice feel that their stress and anxiety levels are now worse compared to before the pandemic, while 45% reported feeling stressed and anxious on a weekly basis. 

Patients are unlikely to see any deterioration in service quality: 81% of respondents still believe they are making a positive difference to their patients, while 65% and 62% respectively feel supported by colleagues and are able to do their jobs effectively. 

However, they may unknowingly encounter more healthcare staff and clinicians who are outwardly calm but inwardly struggling.

The heat is on 

Every independent practitioner will have personal challenges, from health and career to relationships and family, but there are some commonalities. 

Inflationary pressures on practice running costs, for example, are likely to cause financial strain. 

Practitioners will have seen their management responsibilities increase, too, as they are expected to collate and submit more information more frequently to different organisations: the Care Quality Commission (CQC), the Private Healthcare Information Network (PHIN) and the hospitals where they hold practising privileges, to name a few.

And despite the pandemic, there has been no remission in medico-legal pressure and scrutiny. 

Doctors have had to keep pace with rapidly-evolving professional and clinical guidance as well as respond to patient complaints about pandemic healthcare provision, such as remote consultations, delays and mask-wearing. 

The long-term upward trend in clinical negligence claims is another cause for concern. 

Being involved in a clinical negligence case often feels very
personal for independent pract­itioners because they – rather than the hospital – receive the initial solicitor’s letter setting out the allegations and criticising their practice. 

And while the MDU closed 85% of claims against our medical members without paying damages in 2021, the civil litigation process can drag on for many years. 

This situation is inevitably an anxious time for doctors, even with the support of their defence organisation and family.  

Sleepless nights

Of course, it is the possibility of a GMC complaint which is most likely to cause sleepless nights. Being notified of an investigation can be distressing and the emotional strain is often compounded by a fitness-to-practise process which is unnecessarily prolonged, leaving the practitioner in limbo.  

The GMC has rightly introduced measures to support those under investigation and has made efforts to be transparent about the deaths of doctors by suicide while under investigation or monitoring. Its first report on this issue was published in March 2022. 

However, it has been constrained by outdated legislation when it comes to making the process faster and fairer and we were dismayed in July, when the Government announced it was shelving the necessary GMC reforms until 2024-25.

What support is available for independent practitioners

This could be the toughest period that most independent practitioners will face in their professional lives – but they do not have to deal with this alone.

On the medico-legal side, practitioners should be able to look to their medical defence organisation for advice and support as well as legal representation and indemnity. 

In addition to core services, such as our 24-hour advice line and the pastoral care provided by our medico-legal advisers and in-house legal team, the MDU has launched a number of initiatives to support doctors’ well-being. 

For example, we started our Peer Support Network in 2020, which put members who were feeling the strain of a GMC investigation or negligence claim in touch with a fellow member who had been through the same experience and could provide reassurance, practical advice and a shoulder to lean on. 

The scheme has been so well-received that we extended it to include members involved in complaints or inquests. 

We also support external organisations that provide help to struggling doctors and point members to these resources. 

Dr Clare Gerada, chairwoman of Doctors in Distress, talked to us about the charity’s work and the issues surrounding doctors’ mental health. 

And we were able to donate more than £30,000 to the Doctors Support Network and the Royal Medical Benevolent Fund on behalf of our Foundation Year 1 members thanks to a scheme where we reduced their subscription from £10 to £5 and they donated the difference. This scheme will continue in 2022.  

Seek help if you’re struggling

Our joint survey with Independent Practitioner Today shows that independent practitioners are not shielded from the stress and anxiety caused by the pandemic and a host of other factors. 

Sadly, the fact that nearly one-third of respondents said that they often go to work when they do not feel fit or well suggests that many feel they just have to get on with the job, which could have implications for their performance and even patient safety.   

The MDU strongly advises any struggling clinician to seek specialist help, whatever their seniority or healthcare setting. 

There is no need to face mental health challenges alone and the sooner help is sought, the greater the likelihood of making a full recovery.

Dr Udvitha Nandasoma (right) is head of advisory services at the MDU