MA(Hons) CIHM FIHM
Independent Consultant in Practice Management
Fiona is an experienced primary care trainer and facilitator. She is the national RCGP QPA Adviser and has advised on both the original and the review of the Quality and Outcomes Framework of the 2004 GP contract
General practice is a highly rewarding and challenging working environment. In many practices, staff are so loyal and committed to the practice that they stay for years and it's not for the money. While acknowledging that, there must only be a handful of practice managers throughout the UK – if any – who would not say that working in general practice can also be highly stressful.
In November 2007, People Management, the magazine of the Chartered Institute of Personnel and Development, said that 25% of fulltime workers were "generally stressed", and 23% of fulltime workers never take a break.(1)
By November 2008, a report commissioned by Friends Provident stated that 25% of the people surveyed were planning to work more hours in the next six months, 61% were more stressed and 11% said that the source of the majority of their stress was work, principally caused by colleagues and bosses.(2)
Add to the equation the continuing pressures on general practice to measure performance, take part in government initiatives such as practice-based commissioning, maintain profits, cope with swine flu and deliver a population-wide additional immunisation programme, and we have a potent mixture capable of producing significantly increased levels of stress for GPs, practice managers and their teams.
The Health and Safety Executive's (HSE) new website giving guidance on managing stress in the workplace defines stress as "the adverse reaction people have to excessive pressures or other types of demand placed on them" – and clearly this has the potential to cause harm to workers.3 Stress that lasts for an exceedingly long period of time, or which is in itself excessive, can cause mental and physical illnesses to develop.
Symptoms of stressed staff may include:
The HSE website also identifies contributing factors such as:
Significant numbers of staff in general practice will recognise these factors in their own behaviour or that of colleagues, including GPs.
Clearly, there is significant risk of detriment to the practice. Absence rates may rise, performance may suffer and conflict between team members may start to develop.
Under the Health and Safety at Work Act 1974 and the Management of Health and Safety at Work Regulations 1999, employers have a legal responsibility to ensure the health of their employees while at work, and this includes being responsible for minimising the risk of stress-related illness.
What should be happening in practices to try to mitigate the effects of the particularly stressful period we are working through at present?
What should the GPs be considering?
GPs are ultimately responsible for the safety of their staff, and at partner level in a practice the following issues could be considered:
What action should managers take?
In most practices, the manager has responsibility for implementing the Health and Safety Policy, and in many practices the manager would work with the GPs to ensure that the points above are actioned. But what should managers be doing in addition?
What action should staff take?
Staff also have responsibilities under Health and Safety legislation. They should take reasonable care of their own health and safety and the health and safety of others likely to be affected by their actions. Staff should:
Helpfully, the HSE has also developed a set of management standards for work-related stress (see Resources). These are straightforward and simply reflect good practice, but could be extremely useful in supporting a systematic approach to this risk area.
These standards do not purport to eliminate stress in the workplace, but rather help organisations effectively control and manage it. The standards examine ways that work is designed in order to identify ways of minimising resultant illness, poor performance, sickness absence, turnover and other harmful consequences of stress in an organisation.
Additionally, they help employers to demonstrate good health and safety management practice by taking a stepwise approach to risk management. This involves:
They also suggest ways in which employers can work with staff to support and encourage them in suggesting improvements that could be made in the workplace to reduce stress.
Areas covered by the HSE standards
The HSE's management standards identify the following six areas of work design that are known to be potential causes of stress and related ill-health:
The HSE Stress website (see Resources) also gives examples, including a health service example, of how organisations have applied the Stress Management Standards. The benefits to the organisation and to individuals of effective stress management include the following:
Undoubtedly, launching into a new management project at a time like this just looks like a bridge too far for many of us. However, GPs and their managers have a responsibility to take action to minimise the risk of stress-related illness in the team, and at the very least we should be undertaking risk assessments and putting into place action plans to minimise risk. Also, GPs need to remember to consider what they can do to support their managers!
1. Soriano K. A quarter of UK workforce are stressed. People Management November 2007. Available from: http://www.peoplemanagement.co.uk/pm/articles/2007/11/aquarterofukworkfo...
2. Friends Provident. Britain under Pressure. Wiltshire: Friends Provident; 2008.
3. Health and Safety Executive. Dealing with my stress [homepage on internet]. Available from: http://www.hse.gov.uk/stress/dealingwith.htm