Tips on managing wellbeing in primary care

The organisation of primary care, both at local and national level, plays an extremely important part in promoting wellbeing and preventing burnout within primary care. However, we as individual practitioners, and the primary health care team as a whole, can take many steps to make a major improvement in wellbeing and preventing stress and burnout both for ourselves and for everyone within the primary health care team. Changes made at practice level and at an individual level promote a healthier working environment for staff and patients, reducing the risk of burnout and improving patient safety.

Individual strategies to promote wellbeing

The main principles that are highlighted for promoting individual wellbeing include:

• Find and maintain a healthy work-life balance. Stress levels can be reduced by simple measures such as taking time off, going on holiday, spending time with family and friends, and taking up hobbies.

• Time should be set aside to relax with activities totally unrelated to work. Setting boundaries between work and home life is essential.

• Engage in self-reflection and be vigilant for signs of burnout. Look after yourself both mentally and physically, practise self-care (eg, healthy diet, regular exercise, and good sleep hygiene). Include stress-reducing strategies (eg, deep breathing exercises, yoga, and meditation) into your daily routine.

• Understand your limitations and seek help early. Techniques such as building resilience, mindfulness, cognitive behavioural therapy, mentoring, and coaching may help you to improve your wellbeing, which benefits you, your colleagues and your patients.

Managing wellbeing for primary care health professionals

There have been many articles discussing wellbeing and preventing burnout in primary care. Particularly simple and helpful advice is given in the article 'Ten Commandments for the resilient practitioner' published in the British Journal of General Practice in 2016. Although aimed at GPs, it is equally relevant for all primary care health professionals:¹

Look after yourself as well as your patients

Take time to eat good food and drink fluids at sensible intervals. Use that time to rest for a few minutes rather than trying to work without breaks. Make sure you exercise regularly and prioritise finding time for outside interests, an early night, and some relaxation whenever you can.

Keep a sense of perspective

Being a doctor, especially a GP, will always involve challenges and there won’t be many times when you have it easy. But experience tells us that it will, in time, become more manageable again. You may need to make changes to your work and to your life to retain or regain perspective.

Treasure time away from work

Home should be a sanctuary, protected and safe, away from the stresses of the surgery. Try to avoid taking paperwork home. Use every single day of your holiday entitlement, because you’ve earned it and you need it. Plan and book your holidays well in advance so that you have a period for recovery in place. A holiday on the horizon will boost your resilience.

Don't be too hard on yourself when you make mistakes

As long as you learn something from them. It is inevitable with the volume of patient contacts, short consultation times, and workload pressure that sometimes you will get things wrong.

Punishing yourself mercilessly is self-destructive and not helpful. Mistakes are painful experiences but can also be valuable feedback.

Analyse why you made that particular mistake and whether you can learn something. Look for patterns in the situations where your mistakes tend to occur. Identifying these is the most important step in figuring out how to avoid them in future.

Accept that on some days being adequate is acceptable

Some days the job can feel overwhelming. When your surgery is running late, packed with patients with complex needs, and you are being bombarded with extras and urgent questions, you need a strategy to get through it.

It’s then about surviving without making serious errors, not about practising perfect, textbook medicine. You need to get your head down and plough through the work as best you can. In these situations, understand that you will need to prioritise.

You may need to defer some patient issues or assessments until another day. Understand that it’s all right to do this when absolutely necessary as long at it doesn’t happen every day.

Sit down and talk with close colleagues every day

It’s a wonderful opportunity to learn, discuss cases, exchange views, ensure fairness of workload, and support each other. Share success stories and allow others to share their successes with you.

Nurture your relationships with colleagues and staff. Sometimes it may help to share your feelings one-to-one with a trusted friend, someone who understands you and who understands general practice. Use them for support when you need it and support them when the situation is reversed.

Learn how to say ‘no’ sometimes

The enormity of workload can feel insurmountable. No doctor is an inexhaustible resource so it is essential to be able to say ‘no’ at times.

This applies when dealing with colleagues, employers, commissioners, secondary care, and sometimes patients. Accept that you cannot be everything to all people and ask yourself, ‘Where can I be most effective?’ Target your energy wisely.

Develop outside interests

This will help you to have respite from the intense working environment of primary care. You might also find it helpful to develop an interest within medicine. Although it can feel like extra work, it may help to keep you sane.

Consider developing an area of clinical expertise, become a trainer, or get involved with medical politics, commissioning, research, the RCGP, or writing. Expose yourself to enthusiasts; their passion is infectious and energising.

Don't ignore early signs of burnout

Every GP is at risk of burnout. Warning signs include: a sinking feeling on a Sunday night, anxiety and apprehension before work on a Monday morning, using alcohol to de-stress, losing the ability to think clearly, becoming less efficient, procrastinating, over-investigating, and over-referring.

If this is happening, take action and do not delay. Put aside time to share these feelings with a trusted colleague, a loved one, or your own GP. Reflect on where this is heading if things don’t change.

Early recognition and an action plan may restore your happiness and relationships, enable you to avoid complaints, and even save your career. If you don’t act it will probably get worse, so don’t wait until you reach the point of no return.

If you are worried you may be heading towards burnout or have already reached that point, it may be work using the BMA resource 'Worried you may be burning out? (see reference link)

Strategies to promote wellbeing for the primary health care team²

The wellbeing of each individual primary care practitioner and all other members of staff is dependent on the culture of the primary health care team. The wellbeing and support of the team is crucial for each individual within the team.

Therefore, in addition to each individual taking steps to improve and maintain wellbeing, it is also vital for the primary health care team to focus on the wellbeing of the whole team and of each individual.³

Strategies that can help and support the primary health care team to be happy and, therefore, to work as an effective and caring team include:

• Make the wellbeing of all staff central to the culture of the practice.

• Create a safe and healthy work environment.

• Provide good-quality lighting and ventilation, reduce noise pollution, and ensure that premises are well maintained, comfortable, and clean.

• Create a room or space where staff can go to relax.

• Encourage communication and generate trust. Organise regular formal and informal meetings, empower all staff to have a voice, and make time to listen and be compassionate.

• Cultivate a ‘no-blame’ culture in the workplace, encouraging reflection and learning from mistakes. Recognise and show appreciation for all the hard work and when things go well.

• Introduce and follow policies such as anti-bullying and anti-discrimination initiatives, and conduct staff risk and wellbeing assessments.

• Facilitate social interaction and organise activities.

• Implement supportive mentoring schemes to help all of the primary care team to manage stress or issues related to home or work.

For further advice about managing wellbeing, see the 'Preventing burnout in primary care' section at the end of Burnout in Primary Care.

There are many resources to help individuals and practices maintain wellbeing and avoid burnout. Some of these resources are outlined in Resources for Healthcare Professionals in Managing Burnout.