Martin L, McDowell A. The professional resilience of mid-career GPs in the UK: qualitative study. Br J Gen Pract 2021; DOI: 10.3399/BJGP.2021.0230.

GPs have similar stressors to GDPs

Increasing demands on general medical practitioners (GPs) in the UK, - such as loss of autonomy, increased administration and working in a complaint-driven culture - may lead to work-related stress and burnout. Mental health support may avoid dealing with the root causes of the problems. Strategies to improve the resilience of GPs aim to overcome work demands, but there is no agreement on how resilience is defined, measured nor its effect on patient care.

Using a convenience sample gathered via social media and other networks, 27 geographically diverse UK GPs with >5 years' experience of general practice were interviewed to identify positive and negative influences on their resilience. Resilience meant 'feeling mentally and physically well, (enhancing) the experience of caring for patients', 'coping and not letting the workload overcome them' or an ability to manage non-work life events, adapting to change and maintaining an ability to carry on working.

Work-related positive influences on resilience included good leadership within the practice, clinical competence, good communication and sharing responsibility. Continuity of care for patients and sharing break times with colleagues during the working day were also important. External positive influences included having supportive relationships and hobbies or interests outside of work. Involvement in non-clinical roles in education, charity or private enterprise were valuable to job satisfaction. Whilst social media fora may have replaced face-to-face support spaces for some GPs, others found social media difficult and sometimes hostile.

Negative external factors included top-down change imposed by government, regular changes to the GP contract, excessive regulation, a target-driven culture and a hostile public perception of the profession. Work-related negative influences on resilience included staff absence, problems with recruitment, rising list sizes, increasing patient demand and expectations, and lack of a career structure. Some personal factors mentioned were poor work/life balance, caring responsibilities outside of work, a tendency to be self-critical and the emotional burden of absorbing patient distress day by day.

Refusing additional workload and reducing clinical working hours were mentioned by many as coping strategies. Resilience may also be seen as a superficial act, remaining stoical in adversity, working efficiently but with little emotional involvement.

Understanding resilience is important for workforce retention and planning. Reduction in hours of individual GPs as a coping strategy has unintended consequences of reducing the resilience of NHS general practice as a whole. Ironically, some GPs saw 'resilience' as another task which needs time and resources to manage.