GPs' lives are commonly regarded as stressful and concern is often expressed about levels of morale in the NHS in general. GPs' morale is typically described as:
‘… a current concern in the United Kingdom because of difficulties with recruiting and retaining the workforce needed to meet the targets of a primary care led NHS’.1
As part of a sabbatical in 2004 I interviewed 19 registrars I had trained in my inner-city practice. During our conversations we talked, inter alia, about morale. While the concept of morale is familiar, and trusts are expected to ‘survey staff morale and motivation’, measuring it is not a well-defined science. I, therefore, simply asked each doctor to anecdotally describe their own current morale on a scale of 0–10.
The results: Most ex-registrars (age range from early 30s to early 60s) described ‘high’ current morale (15 suggested 8/10, one 7/10, one 6/10). Only two described ‘low’ levels (of 3 and 5).
NEGATIVE INFLUENCES ON MORALE — WHAT REDUCES YOUR MORALE?
Partnership stresses
Interviewer: How low's it been?
GP: Two or three.
Interviewer: When?
GP: In (a difficult) partnership.
I ve got trouble from the senior partner so it wavers between 9 and 0 depending on his mood.
The work–life balance
Not being in the right place. I just couldn't get the right balance of work … I had personal things going on and I just needed to have a change, I think I was a bit burnt-out.
Academic hurdles
When I recently re-sat my MRCGP my morale was probably 1 out of 10.
One is coping with a long-term illness.
(It's currently) 6, 7 out of 10, which is pretty good. I've perhaps got mild depression but it's nothing too serious for me.
Being abroad may be tough
I think it's in part being in a foreign country.
Both of those who described ‘low’ morale levels (of 3 and 5) were experiencing career delays; one had had difficulty in completing training and the other was working on past the usual retirement age. (Powerlessness and lack of control have been described as pervasively negative influences on morale.)
I ve got a horrible feeling come August I won't have a job.
I think I should have come home (from overseas) a lot earlier.
At the time of the interviews (April to July 2004) there was general optimism about increased new contract funding, promised to benefit income and pensions, and GPs were no longer responsible for out-of-hours work:
The out-of-hours changing, that's taken me up from a 6, probably a 5 or 6 at times, to an 8 or 9, it's made such a fantastic difference … the junior partner was on every Friday night.
Despite national concerns about the morale of the NHS workforce, and the common stereotype of stressed-out or burnt-out GPs, this group, though faced with the launch of an elaborate new contract and the oft-mentioned increasing expectations from patients and society, largely described high current morale.
Huby et al1 found that the complex relationships between workload, personal style, and partnership arrangements were the most important factors influencing GPs' morale; the dynamics between these factors were critical.
In Counting the Smiles, the Kings Fund Review2 suggested that four factors affect morale; the working environment, feeling valued, job satisfaction, and resources and pay.
In this group, mostly comprising a mix of salaried and principal GPs, partnership problems and job insecurity were mainly identified as causes of lowered morale. No-one mentioned finance as a negative or positive factor.
How typical were they? This group had all chosen to train in the inner city, often having experienced unusually challenging incidents and situations before and during their GP training year. Does their high morale reflect unusual individual hardiness and adaptability, and was this resourcefulness even enhanced by having survived such experiences while training? Perhaps Darwin has the last word:
It is not the fastest or the strongest who survive, it is the most adaptable.
Notes
Funding body
My prolonged study leave was supported with an RCGP scientific foundation grant (SFB 2004/01).
- © British Journal of General Practice, 2006.