Mental Health and Resilience in FCP - What can we do?

Introduction

This is going to be a very different type of post to my usual evidence-based reviews and condition reviews. This is going to be a raw one! It's going to incorporate a lot of my own personal experiences and my own struggles. This is positive though!! It's going to be about what we can all do to support each other and what you can do personally to look after yourself.

We're all really good at looking after our patients. We're all really good at pushing our own feelings out of the way as we are taught to in order to treat the patient in front of us. So, let’s take a moment to think about ourselves.

Primary Care and FCP - is it a recipe for all of this?

So, this is going to be my 'why' section. Why do you think in one study there was a reported 78% of clinicians who were either exhausted or at risk of exhaustion?

This is high and very worrying!

When I think of my own practice I come home from my clinical days and feel very fatigued. Yeh work is tiring, and I get that. There is a lot of driving involved in my commute also which naturally is tiring. However, I think the FCP role in general is to blame for some of this as well as Primary Care in general.

What do I mean by this? Simple - In primary care and in FCP we are constantly under pressure. We feel the pressure of always needing to do more, see more patients, keep on top of everything. I think there is also an element of decision fatigue - we need to make decisions all day every day. There isn't a moment to switch off and do some mundane tasks like there might be in other jobs or roles.

I think there is also the pressure that we feel in the whole team and system. The NHS as a whole is struggling still after COVID. Routine ops were cancelled. Clinics were cancelled. This has caused a massive backlog. Where do patients all go to access these services and chase up referrals - Primary Care Clinicians. How many times have you explained the timescales that are beyond your control? I think all this takes a toll.

So why do I think the job is also to blame even if we take out these more external factors? FCPs are specialist musculoskeletal clinicians. I personally feel the burden of this! We go in every day to see patients who are undifferentiated and undiagnosed. This requires a lot of reasoning and brain power! I feel there is a lot of pressure to be a one stop shop. I should know what is going on (if it is MSK of course!) and I shouldn't miss any red flags also. This is a lot of pressure and I feel I need to be on the top of my game constantly.

So, let's circle back...

Is primary care the recipe for all of this - a perfect storm?

Well, I think the pressures like I have shown above, even if these are perceived rather than true pressures, do contribute to FCP pressure and potential burn out. Multiple studies have shown that GPs are also at high risk of burn out. Therefore, I do feel that the perfect storm of needing to prove ourselves as an asset to the primary care workforce and the external pressures from patients and the wider system do all contribute.

What can we do? - Organisation Level

Burnout is a metaphor used to describe physical and mental exhaustion from work related activity and was first used in the 1970's (Schaufeli et al., 2020).

I first want to recognise my own organisation in this section, Pure Physiotherapy. They are very supportive and adopt a staff first approach and line managers are encouraged to have conversations with their staff on a personal level as well as a work level. Also supporting staff and all staff knowing they are valued are huge things that always come to mind in my current role!

The recommendations here are based off my own positive experience in this organisation as other places I have worked have not always been so supportive - often through no fault of their own - most people don't really know how to handle having people struggling.

Recommendations for an Organisation:

• Talk to your staff regularly - let them know they are valued
• Let them know they can speak out - if they aren't feeling well, if they are struggling, it's always good to know you have someone to go to
• Allow flexibility for time off requests - why is that person taking annual leave last minute? Instead of declining requests consider checking in and seeing what's going on.
• Check in on people's workloads - is there something you can do to allow the time for reflection?
• Encourage reaching out for help - normalise reaching out for clinical help and making sure people don't feel isolated as research shows the uncertainty in primary care can often lead to burn out

What can we do? - Personal Level

So, it's not all up to your employer to ensure you are managing the stressors in your job. Stressors are there in any Physio job - we deal day in day out with people. People are unpredictable and everyone is different. That's often one of the things most people (me included) like about this job! In the FCP role this turns up a notch as not only are we considering MSK and 'physio' pathologies we are now screening for things that might not be as they seem.

How can we manage this?

So again, this section draws on my own experience and strategies which I have found helpful to manage the stress and reduce the risk of burn out. Some may work for you, some may not. There is also evidence behind a lot of these.

What can I do?

• Debrief with yourself - give yourself time at the end of the day, even if it's on the commute home to run through the day. Think about what went well, what you'd do differently and any learning that stands out.

• Share with your supervisor - I'm guilty here of often having a barrier up between my work life and private life. If things are going on that are big and impacting you then it's important to share these, no one can help even with sudden Annual Leave requests (for example) if they don't know!

• Journal - I find this in general really helpful in my personal life just to throw down some reflections of things that have happened and reading it back and typing it out really helps to process everything. Bringing this into your FCP life is also useful, those difficult patients, those frustrations - process them!

• Regular time off - your Annual Leave is there for a reason! Don't save it all up until the end of the year. look to plan it throughout the year taking time off regularly to recharge is really beneficial and having that time planned in gives you something to aim towards if times are tough.

• Hobbies - remember to use time outside of work for you. Something active often helps with stress and if its outdoors then studies show this is even more of a bonus.

• Meditation - taking some time to unwind can really help. This can be something as short as a few minutes in lunch just to switch off apps like Headspace offer free NHS staff access. Find out more here

How to recognise stress

This is hard! Everyone is different!

The British Medical Association tells us the signs could be any of the following:

fatigue
poor concentration
lack of energy and effectiveness
cynicism
detachment
frustration and irritability
substance misuse
lower work standards
changes in – and inappropriate – behaviour

However, I feel that's a very specific list and it seems they did too as at the bottom it states to think about yourself and if you're not feeling like yourself, it's important to acknowledge this

I think this is better and I would also think to consider how you are feeling in general, how you are feeling after work and how you are feeling on your days off (at the weekend for example) if everything is feeling too much even on your days off then that's a big problem. If things are feeling too much after work, then maybe putting some strategies in place like the ones above are likely to help. If you are feeling low, not yourself or anxious generally then it may be time to consider having a conversation with a GP.

I would also consider when you last managed to do something for you. When did you last do one of your hobbies? If this is a while ago then consider why also

Resources and how to access support

Wellbeing hubs - these are new and there are loads of them around the country. Simply search your county (e.g. greater Manchester) and then wellbeing and resilience hub and there contact details will come up. Really good with signposting and practical advice and checking in with you!

Headspace - really good app that gives a range of meditation and mindfulness support. I’ve been sceptical of mindfulness for a while, but this really changed my mind and really helps!! Link here

Day one - this is the journal app I use - free to use and you can upgrade if other features are required. Good templates too to structure things if you're not sure where to start. Link here

BMA - this article from the BMA has some handy tips in How to recognise the warning signs of burn out

Counselling - it is useful to talk to someone about problems. I've again been sceptical about counselling in the past but it has really helped me so I would encourage you to give it a go if you are struggling. Often it can be accessed via your workplace’s occupational health department or health plan - check these out as there is often no wait.

Colleagues and Friends - reach out, you'll be surprised how good it feels to get off your chest you are struggling and to do things with other people. It will really help to spend time with people - a good laugh can really help!

Let me know in the comments below any other ideas you have or things that have helped you!! It'll be useful for everyone no matter how small or insignificant it seems!

Reference List

[1]E. Demerouti, A. B. Bakker, F. Nachreiner, and W. B. Schaufeli, ‘A model of burnout and life satisfaction amongst nurses’, Journal of Advanced Nursing, vol. 32, no. 2, pp. 454–464, 2000, doi: 10.1046/j.1365-2648.2000.01496.x.

[2]J. J. Ferguson, A. Fritsch, C. Rentmeester, D. Clewley, and J. L. Young, ‘Feeling exhausted: How outpatient physical therapists perceive and manage job stressors’, Musculoskeletal Care, vol. 21, no. 3, pp. 845–855, 2023, doi: 10.1002/msc.1761.

[3]Sophia Bourne, ‘How to recognise the warning signs of burn out’, The British Medical Association is the trade union and professional body for doctors in the UK. Accessed: Dec. 23, 2023. [Online]. Available: https://www.bma.org.uk/news-and-opinion/how-to-recognise-the-warning-signs-of-burn-out

[4]L. Morris, P. Moule, J. Pearson, D. Foster, and N. Walsh, ‘Patient acceptability of the physiotherapy first contact practitioner role in primary care: A realist informed qualitative study’, Musculoskeletal Care, vol. 19, no. 1, pp. 38–51, 2021, doi: 10.1002/msc.1505.

[5]S. Ingram, R. Stenner, and S. May, ‘The experiences of uncertainty amongst musculoskeletal physiotherapists in first contact practitioner roles within primary care’, Musculoskeletal Care, vol. 21, no. 3, pp. 644–654, 2023, doi: 10.1002/msc.1735.

[6]L. Nozedar and S. O’Shea, ‘What is the prevalence of burnout amongst first contact physiotherapists working within primary care?’, Musculoskeletal Care, vol. 21, no. 3, pp. 776–785, 2023, doi: 10.1002/msc.1752.