1. West Sussex Practice Managers Association
DocHealth
West Sussex Practice Managers Association
8th June 2017
Doctors in Difficulty - DocHealth
Dr Antony Garelick
Head of DocHealth
Consultant Psychiatrist in Psychotherapy
British Medical Association, London
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2. What is the DocHealth service?
Self-referral
Psychiatric and psychological assessments
Up to 6 sessions
Addresses work, personal or career related problems
A network of resources
Confidentiality (within explicit limits of patient)
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3. Nature of service Clinical assessment and brief treatment service
Holistic, narrative based, psychodynamically informed consultation
Help doctors identify and clarify the nature of their problems and how they interact with their professional and personal lives
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4. Stigma
Firth-Cozens Problems frequently long-standing, untreated, and appear proportionately higher than in other occupational groups
External - adverse effects on career
Internal - shame, fear of failure
Conflicts with still prevalent role model of the invulnerable clinician able to cope with any professional stress
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5. Work Environmental Factors
What makes us ill
Work Environmental Factors
Societal
Factors
THE INDIVIDUAL DOCTOR
Clinical
Factors
Physician
Personal
Factors
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6. Seven key early warning signs
The ‘disappearing act’: not answering calls, unexplained absences during the day; lateness; frequent sick leave
Low work rate: slowness in doing procedures, clerking patients, dictating letters, and making decisions; arriving early, leaving late and still not achieving a reasonable workload
‘Clinic Rage’: bursts of temper; shouting matches; reacting badly to real or imagined slights
Rigidity: poor tolerance of ambiguity; inability to compromise; difficulty prioritising; inappropriate ‘whistle blowing’
‘Bypass syndrome’: junior colleagues or nurses find ways to avoid seeking the doctor’s opinion or help
Career problems: difficulty with exams; uncertainty about career choice; disillusionment with medicine
Insight failure: rejection of constructive criticism; defensiveness; counter-challenge
Stevens, R, Dr, Royal Medical Benevolent Fund, The Vital Signs in Primary Care, 2016
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7. Organisation Pressures
Government
Maximum power
NHS Executive
Purchasers
Pressure
Coercion
Targets
Management
Consultants
Trainees
Minimum
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8. Transfer of care
Delayed transfers of care out of hospital rose by 41% in the last 6 years, increasing pressures on hospital beds and preventing patients from returning home.
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9. Hospital beds
Between 2006/7 and 2015/6 the number of overnight beds decreased by over a fifth. There has also been a 44% decrease in the number of mental health beds since 2000/1 and a drop in maternity beds by 13% over the last 10 years.
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10. Waiting times
Number of patients waiting more than 4 hours to be admitted to hospital from A&E peaked at 14.8% in November 2016.
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11. NHS funding
By 202/21 the NHS in England will have a mismatch of nearly £30bn a year between resources and patient needs. Hospital debts hit a record £2.45 bn at the end of 2015/16.
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12. Workforce
The UK population has fewer doctors per person than other leading European economies. Physicians per 1,000 people:
UK: Italy: 4.2
Germany: 4.1
OECD average: 3.3 France: 3.3
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13. General practice
A third of GP partners are unable to fill vacancies. 84% say their workload is affecting the level of patient care.
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14. Problems with team working
Absence of an agreed aim
Ambiguous roles and responsibilities
Lack of agreement about what working together means
Problematic power relationships
Ideological differences
Conflicting models of care
Cynicism/loss of faith (detached/depersonalised working)
Partners – Salaried Doctors
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15. Addressing morale, stress and burnout
Need to focus on both the individual and the system
Huby et al. BMJ , 325 (7356):140
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16. Maslow’s hierarchy of needs
This is represented as a pyramid with the more basic needs at the bottom
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17. Doctors’ feedback
Want greater understanding of what generated their problems
Importance of being in charge of ones own destiny
Want more than protocol driven approach
Value knowledge as a means of autonomy and self worth
Halpert, E, International Journal of Psychoanalysis
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18. DocHealth
DocHealth
An Independent Confidential Consultation Service for Doctors by Doctors Tel: Website:
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