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Sunday 17 December 2017
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Dealing with bereavement in a practice

Bereavement is one of the most challenging experiences anyone will ever face. Debbie Kerslake, chief executive of Cruse Bereavement Care, explains how to cope with bereavement at your practice.
Bereavement in a practice

Bereavement is one of the most challenging experiences anyone will ever face. Debbie Kerslake, chief executive of Cruse Bereavement Care, explains how to cope with bereavement at your practice

For the GP whose partner has died after a long illness, the practice manager whose sister has been killed in a road crash or the receptionist returning to work after a miscarriage, bereavement can be overwhelming. 

Dealing with bereavement in the workplace presents a different set of challenges. It is estimated that one in 10 of the workforce is going through bereavement at any one time, and every death has a ripple effect. The loss of a colleague, for example, can have a profound impact on everyone working in the practice. 

But health workers are also likely to experience the death of a patient at some time in their career. Many will develop resilience, but some patient deaths will be particularly hard to
deal with. 

For example, the death of a patient with whom you’ve established a relationship over many years or a patient who has taken their own life may strike a significant chord.  

Cruse Bereavement Care is the largest provider of bereavement support in the UK, which supported nearly half a million people last year. Confidential support is provided to anyone who is bereaved, no matter how or when it happened. Support can be accessed in a variety of ways: face to face; by telephone or email; and through cruse.org.uk and, for children and young people, hopeagain.org.uk.   

Every bereavement is unique and responses are individual. Assumptions should never be made, but some factors are known to impact a person’s grief and their ability to cope. These might include the circumstances of the death, the nature of the relationship with the person who has died, the bereaved person’s health and the support network they have around them. 

There may also be formal processes to undergo – for example a court case, inquest or public inquiry – which will inevitably take their toll.  

However, even the ‘expected’ death of someone elderly who’s been ill for a long time can be traumatic and extremely difficult to deal with.

There is no right or wrong way to feel after a bereavement. The shock many people feel immediately after a death can make it difficult to take in what has happened. People feel numb but may initially carry on as normal, appearing to be coping well. Feelings of pain and distress may come later and emotions can feel out of control.

Grief can badly affect a person’s concentration, making it difficult to focus on the simplest of tasks. It can lead to loss of appetite and problems sleeping. Bereavement can even make somebody think they’ve seen the person who has died, or heard their voice. They may constantly go over the details of the death or the last few days preceding it. Guilt, anger, despair and feeling that life no longer has meaning are common reactions. Bereavement itself is not an illness, but it can have a significant impact on mental and physical health.   

For some people, grief can become so devastating that they are unable to function normally – the feeling of loss of control can be crushing. Many contact Cruse’s national helpline saying they feel like they are ‘going mad’; some are so overwhelmed by the intense emotional pain that they consider taking their own lives.

Bereavement can be a frightening and isolating experience, and there is no time limit to anyone’s grief. Its impact on emotional, physical and psychological wellbeing can be long lasting and profound. Support needs to recognise this.  

What does this mean for a GP practice?  

Bereavement in any workplace impacts on productivity, morale and staff retention. It can be challenging to manage appropriately. Employees may have to take time off unexpectedly when someone dies; their work will often be affected and they may be unable to perform certain roles. 

However, there are ways that you can prepare for these situations to make sure effective support is in place when someone experiences a significant loss, and to help ease some of the pressure on the workforce. Implementing staff training and establishing a robust bereavement policy are good starting points.

Training is important in developing skills and confidence and ensuring managers and colleagues are comfortable talking about bereavement, from the first news of a death through to managing a return to work and providing ongoing support. 

A bereavement policy is a vital resource for any workplace. It should offer guidance on what people can expect to happen if they are bereaved, including bereavement leave entitlement (paid and unpaid) and employee support arrangements.  

The Employment Rights Act 1996 grants employees the right to ‘reasonable’ time off work from ‘day one’ to deal with an emergency, which includes the death of a dependant. This could be a spouse, partner, child, parent or someone who depends on the employee for care. 

But the current lack of statutory bereavement leave places the onus on employers to decide what provisions to have in place for bereaved staff to enable them to deal with the immediate aftermath of a death – both the practical considerations and the emotional impact.  

How you deal with bereavementin the workplace is not just about policies and procedures: equally important is care, compassion and sensitivity. 

For example, when the receptionist phones in saying her mum has died, how does her line manager react? What words do they use? What support do they offer? What do they talk about in this initial phone call? How do they acknowledge what has happened? In the following days, does the line manager make contact with the bereaved receptionist or offer any ongoing support? In the longer term, how is her return to work planned?  

Coming back to work can be a real challenge for some, but others will be relieved to have something else to focus on. 

The nature of the work can be a factor. It might be harder to return to a role that involves contact with bereaved people, taking calls from people in distress, discussing pregnancy terminations, or working with patients who have a terminal diagnosis. If someone is struggling to concentrate or cope with their work, they might worry about making mistakes – and for healthcare professionals, those mistakes could have grave consequences.

There may be changes to a bereaved person’s personal circumstances to take into account, such as new caring responsibilities. This might mean they need extra support, like a phased return to work, flexible hours or alternative duties for a period of time. 

It is vital that all kinds of difficulties in coming back to work are acknowledged: a bereaved person may be feeling vulnerable or lack confidence, and they may not be able to perform at the level or capacity  you and they are used to. 

Colleagues and line managers all play a role in supporting a return to work after loss.   

Grief does not run a smooth course and there are no time limits. It takes time, so it’s important to check how the bereaved employee is coping following a return to work. One option could be to organise a ‘buddy’ system, where a designated co-worker is available to listen if the person is having a difficult day. 

The bereaved employee may need a place to go for a quiet moment if things become too much for them at any point. 

It is also important to be sensitive around anniversaries and special days, such as a birthday. Ask – and listen to – how they’re feeling and what they need at the first opportunity, and keep listening as time goes on. 

Throughout, it is essential to ensure a bereaved employee has information about external sources of support, particularly those with expertise in bereavement that can provide a range of services in different formats. 

People who are grieving may need different types of support at different times, from face-to-face meetings, emails, someone to talk to on the phone, or counselling. The key is to work together with the bereaved person to find the best solutions for them.

Death of a colleague  

When a colleague dies, it can have a significant impact on everyone who worked with them. The practice will need to consider a range of issues:

  • Communicating the news of the death to staff and patients.
  • Contacting the family to extend condolences, discuss practical arrangements and offer support.
  • Providing support for all staff who need it.
  • Enabling staff to attend the funeral or memorial service.
  • Commemorating the person’s life – for example, naming a room after the person or displaying a photo on the wall of the surgery.  

Some people might be reluctant to discuss or show their feelings at work, but giving employees the opportunity to acknowledge their shock, sadness and loss is important and should be an ongoing process.

GPs and partners may feel that, as senior members of staff, their role is to support others. It can be difficult for some to acknowledge that they need help thelmselves, so it is important that their needs are not sidelined. 

Managing workplace bereavement is not just about how many days someone takes off on compassionate leave. It is about the total package of care and support from everyone in the workplace. Getting it right helps build trust and commitment, reduces sickness absence and improves staff retention and relationships. It reflects a culture that values people and ensures they get support when they are at their most vulnerable.       

The Advisory, Conciliation and Arbitration Service (ACAS), in conjunction with Cruse, has published a useful guide to managing bereavement in the workplace cruse.org.uk/news/bereavement-at-work.