Following the recent sad news of the suicide of Surrey GP partner Gail Milligan it is timely to consider what factors are placing us all at risk and what active steps we can take to look after ourselves as GPs. 

Factors which can contribute to burn out include working in excess of contracted hours such that your personal boundaries (work-life balance) are not respected (specially with unpredictable finish times), working within contracted hours but at high intensity and feeling unsafe, and working in isolation and at the limits of your experience or confidence without support.  

Only too often salaried GPs will walk away from a job because they feel they cannot cope and cannot change the job. Once there has been an exodus, then the practice rethinks its approach to its salaried GPs. Is there a better way to avoid this cycle of repeat attempts at recruitment and failed retention?

Here are some conversations for salaried GPs to consider with their employers:

• Complete a work diary (there will be a new app called Dr Diary available soon for this) to monitor your actual hours. If this exceeds your contracted hours discuss this with your employer with a view to backdated remuneration and an amended job plan going forward which is consistent with your contract. Your BMA employment adviser can assist you with this. Consider doing this as a group exercise with colleagues. Only when the overtime is priced in terms of pay will employers see the opportunity cost of inefficient working practices like using clinicians to do work which could be done by non-clinicians or other clinicians (such as document management)
• Consider is this the right practice for you? Before walking away consider asking your employer to reduce or drop your on call commitment, to increase appointment length or reduce contacts
• You can also discuss prioritising which activities within your work take priority and which you will cease to do until the employer has reassigned some of the excess work to another member of staff. For example this might be incoming document management (which admin staff can be trained up to do), completion of private medical reports, supervision or teaching of students or trainees, medicines alignment for discharges (which could be delegated to a pharmacist) and so on
• Consider whether some of the excess workload which is causing prolonged hours or unsafe intensity is to do absences for which locum cover is available. Is the employer fully utilising this cover? Are you contractually required to provide this cover beyond the immediate emergency (24-48 hours)? 
• Does the appointment system allow you to follow up your own patients: this is important not just for safety and doctor and patient satisfaction but also is protective against burnout?
• Are there opportunities to join in with informal gatherings and discussion within the practice or does the work intensity prevent this? Does your job plan include mentoring or supervision which is not being offered (retained GP or other roles)?

Paula Wright is a sessional GPs committee member