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Why GPs are leaving the NHS

For the last few years the medical profession have been the main opposition to NHS privatisation - b

Last summer, after nearly a decade of training, Dr Jayne Graham qualified as a GP. She's spent the last three years at an NHS practice in a deprived part of South London, and had planned to stay there. Today, however, she's working for a private clinic in affluent Kent.

Dr Graham - not her real name - hasn't joined the dark side because of some damascene conversion to the superiority of private medicine. Instead, like hundreds of her colleagues, she simply found that the NHS didn’t have enough jobs to go round.

"This isn't at all why I wanted to be a GP, but I’ve got to pay my mortgage," she says. "I believe patients should be treated based on need. But I’m giving out private treatment because I have no other option."

She's not alone. Nationwide, the number of advertised vacancies for GPs has dropped by as much as 70 per cent in the last year. The BMA estimates that 1,000 of this year's crop of graduates – around a third - will struggle to find work.

As a result, young doctors are grabbing any work that's going. Some are working part-time; others as locums, doing the medical equivalent of temping. At least one is driving a London taxi. Others still, with £60k of debt and a quarter of a million pounds worth of training behind them, are doing precisely nothing.

The most worrying contingent, though, are those like Dr Graham who have left the NHS altogether. Several of her colleagues have already made the move ("Where else are they going to go?" she asks, pointedly).

Plenty more are considering it. In 2006, a survey by medical newspaper GP found that less than a third of young doctors would work in the private sector. Last July, when it repeated the exercise, that number was more than half. One of the younger BMA reps says that many of her colleagues are setting up private pensions, "because they don't think the NHS is even going to be their main employer any more."

Comments like this may surprise those who still tremble with rage over six figure pay packets for doctors.

In fact, those are a big part of the problem. The contract that created them works on the basis that the partners in each GP practice split its profits. This, it turns out, is a big incentive not to bring in any more partners. The GPs, of course, place the blame squarely on the government’s refusal to increase funding for the last three years, in an attempt to claw back the embarrassingly huge pay rise of 2004.

But while the BMA and the government have been busy blaming each other, the private sector’s been cashing in. For the last few years the medical profession have been the main opposition to NHS privatisation, leaving business to grumble about medical protectionism. Now, though, companies are scheming to bring doctors on board with cushy pay and conditions. US giant UnitedHealth Europe is offering terms so generous they get praised to the heavens at conferences. Virgin Healthcare is going one better, allowing GPs to keep their NHS status, but co-opting them to the Branson brand so that it can flog private health and dental services to those with spare cash and no patience.

The doomsday scenario here is that general practice could go the way of dentistry, where it’s now all but impossible to get NHS treatment in some parts of the country. Dr Alex Smallwood, who represents GP trainees at the BMA, warns that, if the situation isn’t resolved soon, we’ll "hit a bubble down the line when GPs have all gone private, and there aren't enough to staff the NHS."

That’s unlikely. What’s more probable is that one of the last barriers to the commercialisation of the NHS will start to break down. The more GPs who take private jobs, and discover they aren’t so bad, the more likely the profession will be to rethink its stance on private healthcare.

It's unclear how to solve this mess. The BMA, which has spent much of the last year denying there's a problem, now says it's working on proposals to encourage practices to create jobs. But while its head GP, Dr Laurence Buckman, admits it’s "a very dangerous situation," he adds, "We can't take any concrete steps because GPs are independent contractors". Meanwhile the government gets what it wanted all along: a more competitive NHS, and a way of putting downward pressure on GP salaries.

Whatever happens, things will likely get worse before they get better: the number of GPs being trained up is increasing by 400 next year. Dr Graham won’t be the last doctor who goes private.

Jonn Elledge edits the New Statesman's sister site CityMetric, and writes for the NS about subjects including politics, history and Daniel Hannan. You can find him on Twitter or Facebook.

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“I felt so frantic I couldn’t see my screen”: why aren’t we taking mental health sick days?

Some employees with mental health problems fake reasons for taking days off, or struggle in regardless. What should companies be doing differently?

“I would go to the loo and just cry my eyes out. And sometimes colleagues could hear me. Then I would just go back to my desk as if nothing had happened. And, of course, no one would say anything because I would hide it as well as I could.”

How many times have you heard sobbing through a work toilet door – or been the person in the cubicle?

Jaabir Ramlugon is a 31-year-old living in north London. He worked in IT for four years, and began having to take time off for depressive episodes after starting at his company in 2012. He was eventually diagnosed with borderline personality disorder last January.

At first, he would not tell his employers or colleagues why he was taking time off.

“I was at the point where I was in tears going to work on the train, and in tears coming back,” he recalls. “Some days, I just felt such a feeling of dread about going into work that I just physically couldn’t get up ... I wouldn’t mention my mental health; I would just say that my asthma was flaring up initially.”

It wasn’t until Ramlugon was signed off for a couple of months after a suicide attempt that he told his company what he was going through. Before that, a “culture of presenteeism” at his work – and his feeling that he was “bunking off” because there was “nothing physically wrong” – made him reluctant to tell the truth about his condition.

“I already felt pretty low in my self-esteem; the way they treated me amplified that”

Eventually, he was dismissed by his company via a letter describing him as a “huge burden” and accusing him of “affecting” its business. He was given a dismissal package, but feels an alternative role or working hours – a plan for a gradual return to work – would have been more supportive.

“I already felt pretty low in my self-esteem. The way they treated me definitely amplified that, especially with the language that they used. The letter was quite nasty because it talked about me being a huge burden to the company.”

Ramlugon is not alone. Over three in ten employees say they have experienced mental health problems while in employment, according to the Chartered Institute of Personnel and Development. Under half (43 per cent) disclose their problem to their employer, and under half (46 per cent) say their organisation supports staff with mental health problems well.

I’ve spoken to a number of employees in different workplaces who have had varying experiences of suffering from mental ill health at work.

***

Taking mental health days off sick hit the headlines after an encouraging message from a CEO to his employee went viral. Madalyn Parker, a web developer, informed her colleagues in an out-of-office message that she would be taking “today and tomorrow to focus on my mental health – hopefully I’ll be back next week refreshed and back to 100 per cent”.

Her boss Ben Congleton’s reply, which was shared tens of thousands of times, personally thanked her – saying it’s “an example to us all” to “cut through the stigma so we can bring our whole selves to work”.

“Thank you for sending emails like this,” he wrote. “Every time you do, I use it as a reminder of the importance of using sick days for mental health – I can’t believe this is not standard practice at all organisations.”


Congleton went on to to write an article entitled “It’s 2017 and Mental Health is still an issue in the workplace”, arguing that organisations need to catch up:

“It’s 2017. We are in a knowledge economy. Our jobs require us to execute at peak mental performance. When an athlete is injured they sit on the bench and recover. Let’s get rid of the idea that somehow the brain is different.”

But not all companies are as understanding.

In an investigation published last week, Channel 5 News found that the number of police officers taking sick days for poor mental health has doubled in six years. “When I did disclose that I was unwell, I had some dreadful experiences,” one retired detective constable said in the report. “On one occasion, I was told, ‘When you’re feeling down, just think of your daughters’. My colleagues were brilliant; the force was not.”

“One day I felt so frantic I couldn’t see my screen”

One twenty-something who works at a newspaper echoes this frustration at the lack of support from the top. “There is absolutely no mental health provision here,” they tell me. “HR are worse than useless. It all depends on your personal relationships with colleagues.”

“I was friends with my boss so I felt I could tell him,” they add. “I took a day off because of anxiety and explained what it was to my boss afterwards. But that wouldn’t be my blanket approach to it – I don’t think I’d tell my new boss [at the same company], for instance. I have definitely been to work feeling awful because if I didn’t, it wouldn’t get done.”

Presenteeism is a rising problem in the UK. Last year, British workers took an average of 4.3 days off work due to illness – the lowest number since records began. I hear from many interviewees that they feel guilty taking a day off for a physical illness, which makes it much harder to take a mental health day off.

“I felt a definite pressure to be always keen as a young high-flyer and there were a lot of big personalities and a lot of bitchiness about colleagues,” one woman in her twenties who works in media tells me. “We were only a small team and my colleague was always being reprimanded for being workshy and late, so I didn’t want to drag the side down.”

Diagnosed with borderline personality disorder, which was then changed to anxiety and depression, she didn’t tell her work about her illness. “Sometimes I struggled to go to work when I was really sick. And my performance was fine. I remember constantly sitting there sort of eyeballing everyone in mild amusement that I was hiding in plain sight. This was, at the time, vaguely funny for me. Not much else was.

“One day I just felt so frantic I couldn’t see my screen so I locked myself in the bathroom for a bit then went home, telling everyone I had a stomach bug so had to miss half the day,” she tells me. “I didn’t go in the next day either and concocted some elaborate story when I came back.”

Although she has had treatment and moved jobs successfully since, she has never told her work the real reason for her time off.

“In a small company you don’t have a confidential person to turn to; everyone knows everyone.”

“We want employers to treat physical and mental health problems as equally valid reasons for time off sick,” says Emma Mamo, head of workplace wellbeing at the mental health charity Mind. “Staff who need to take time off work because of stress and depression should be treated the same as those who take days off for physical health problems, such as back or neck pain.”

She says that categorising a day off as a “mental health sick day” is unhelpful, because it could “undermine the severity and impact a mental health problem can have on someone’s day-to-day activities, and creates an artificial separation between mental and physical health.”

Instead, employers should take advice from charities like Mind on how to make the mental health of their employees an organisational priority. They can offer workplace initiatives like Employee Assistance Programmes (which help staff with personal and work-related problems affecting their wellbeing), flexible working hours, and clear and supportive line management.

“I returned to work gradually, under the guidance of my head of department, doctors and HR,” one journalist from Hertfordshire, who had to take three months off for her second anorexia inpatient admission, tells me. “I was immensely lucky in that my line manager, head of department and HR department were extremely understanding and told me to take as much time as I needed.”

“They didnt make me feel embarrassed or ashamed – such feelings came from myself”

“They knew that mental health – along with my anorexia I had severe depression – was the real reason I was off work ... I felt that my workplace handled my case in an exemplary manner. It was organised and professional and I wasn’t made to feel embarrassed or ashamed from them – such feelings came from myself.”

But she still at times felt “flaky”, “pathetic” and “inefficient”, despite her organisation’s good attitude. Indeed, many I speak to say general attitudes have to change in order for people to feel comfortable about disclosing conditions to even the closest friends and family, let alone a boss.

“There are levels of pride,” says one man in his thirties who hid his addiction while at work. “You know you’re a mess, but society dictates you should be functioning.” He says this makes it hard to have “the mental courage” to broach this with your employer. “Especially in a small company – you don’t have a confidential person to turn to. Everyone knows everyone.”

“But you can’t expect companies to deal with it properly when it’s dealt with so poorly in society as it is,” he adds. “It’s massively stigmatised, so of course it’s going to be within companies as well. I think there has to be a lot more done generally to make it not seem like it’s such a big personal failing to become mentally ill. Companies need direction; it’s not an easy thing to deal with.”

Until we live in a society where it feels as natural taking a day off for feeling mentally unwell as it does for the flu, companies will have to step up. It is, after all, in their interest to have their staff performing well. When around one in four people in Britain experience mental ill health each year, it’s not a problem they can afford to ignore.

If your manager doesn’t create the space for you to be able to talk about wellbeing, it can be more difficult to start this dialogue. It depends on the relationship you have with your manager, but if you have a good relationship and trust them, then you could meet them one-to-one to discuss what’s going on.

Having someone from HR present will make the meeting more formal, and normally wouldn’t be necessary in the first instance. But if you didn’t get anywhere with the first meeting then it might be a sensible next step.

If you still feel as though you’re not getting the support you need, contact Acas or Mind's legal line on 0300 466 6463.

Anoosh Chakelian is senior writer at the New Statesman.