Work trouble: Working 9-5 doesn’t always make good living…

As a GP, I am aware that my job influences my own health and wellbeing. Within my consulting room, I see first-hand how experiences of work, and its relationship to physical and mental health, are linked to a range of patient issues.

Being a GP is not an easy job – but it’s good work

‘One in seven GPs use alcohol or drugs to cope’, according to a November 2017 survey of GPs, the rest of which makes similarly grim reading. While I’m horrified by that figure, I’m not surprised. Being a GP has always been a busy job, but GP workloads have increased exponentially over the last 10 years and despite significant efforts by NHS England to boost GP recruitment, numbers continue to fall. The reality behind those stats is that being a GP can often feel stressful and tough. I routinely have 40-60 patient contacts a day, many of whom present with complex problems, some of which may be life threatening.

It can seem impossible to do this job, at this level of intensity, without making a mistake. I live in fear of doing so – there are people’s lives and wellbeing at stake. I want to offer a safe space to listen to my patients, but sometimes I feel my empathy drain as the day, patient numbers and work stack up. In 2017, one in ten GPs reported having taken time off for stress or burnout, and over one in five feared doing so within the next year.

Being a GP doesn’t feel like an easy job, but I’m very aware of its many privileges and the protections those afford me. I have a fulfilling job and I earn more than my lifestyle requires. My workplace is warm and well lit, I have relative autonomy, and I have a contract which provides sick pay and parental leave. My work might not always feel good, but it’s a good job. For many of my patients, it is a very different picture. 

Job insecurity and poor working practices make people ill

As GPs, we regularly see the impact of work on health. Mental health problems account for up to 40% of all GP consultations, and the interaction between work and mental health is often laid bare. The Labour Force Survey showed that 0.5 million workers suffer from work-related stress, anxiety or depression – that’s equivalent to the entire population of Liverpool or Bristol. For some, work is the direct cause of mental ill health, for others, it can play a key role in how quickly they are able to recover from episodes of mental illness.

Take D, a young single mum recently diagnosed with cancer. She’s had major surgery and radiotherapy, but rang me yesterday asking for help with her sick notes – her employer has refused to accept them and she’s now facing an employment tribunal. We discussed how ridiculous the situation is, and the stress it’s causing her. I’ll do as much as I can to support her, but find myself feeling anger towards her employer. Can’t they see that they’re making her health worse? 

Or take M, another of yesterday’s patients who is suffering with a painful knee. The cause isn’t serious, but the problem is exacerbated when work enters the equation. Short breaks might help her complete a working day, but her employer (a chicken factory) won’t let her take any. Her choice is between worsening poverty or worsening pain; to take sick leave (something she can’t afford), or to go to work, struggle through, and make her knee injury worse.

Money is often the elephant in the consulting room

For my self-employed patients, time off to attend appointments, receive treatment, or even to rest and recover, means income lost. That, in turn, can cause stress and impact wellbeing. Other patients who are in precarious work are often reluctant to take off the time they need to recover from illness.

In my experience, most people in employment want to stay in it, but some need help to do so. It can feel frustrating that, while work can play such a massive role in health, there is relatively little I can do to support patients struggling in these scenarios. ‘Fit notes’ allow me to suggest workplace adjustments, amended duties, or a phased return to work to support a patient back to employment, but there is no legal obligation for employers to comply. Sometimes, my patients tell me it’s simply not worth asking.

In my role as a GP I’m a ‘fixer’, and the problems that I can’t fix tend to trouble me. That’s tough, because the solution to many of the problems I see isn’t a simple pill, referral or a listening ear. The social determinants of health play out in my consultation room time and time again throughout my working day. Making more employment good employment is one route to a happier, healthier society.

Dr Rebecca Fisher (@BecksFisher) is a GP in Oxford and a Policy Fellow at the Health Foundation