Burnout in general practice: Could doing audits help?
The paper by Toukhsati et al titled ‘Burnout and retention of general practice supervisors: Prevalence, risk factors and self-care’, published in the AJGP December 2024 Supplement, found that general practice supervisors across Australia reported high levels of burnout and exhaustion.1 We have similar problems in the UK, with a nationwide shortage of general practitioners (GPs) exacerbating difficulties with recruitment and retention.2 However, conducting audits at our London general practice with four bright, keen medical students recently provided a glimmer of hope, encouraging both GPs and students to think general practice is worthwhile. As in Australia, involving students in quality improvement projects is a key element of UK medical education,3 although some students think audits are boring.4
In 2024, four medical students undertook a second round of audits at our inner-city general practice. Three of the audits, focusing on gestational diabetes mellitus (GDM), chronic kidney disease (CKD) and urinary tract infections (UTIs) were conducted by previous students in 2022–23, and one focused on attention deficit hyperactivity disorder (ADHD) in 2021. Under the guidance of our deputy practice manager, anonymised practice data were compiled and patient management was evaluated against UK National Institute for Health and Care Excellence (NICE) guidelines (Table 1).
| Table 1. Medical student audit cycles conducted between 2021 and 2024 at an ethnically diverse inner-London practice with 10,000 patients |
Topic
Author initials
NICE guideline |
Audit question |
First audit findings (2021–23) |
Second audit findings (2024) |
GDM
SK
www.nice.org.uk/guidance/ng3 |
How many women with a history of GDM have had an HbA1C check within the last 12 months? |
44% (16/36) of women had their HbA1C checked |
56% (31/55) of women had the HbA1C checked |
CKD
RH
www.nice.org.uk/guidance/ng203 |
How many patients have two consecutively recorded eGFR <60 mL/min/1.73 m2 and no coding of CKD? |
64 patients with two eGFR <60 mL/min/1.73 m² measurements taken ≥3 months apart had no coding of CKD |
Four patients with two eGFR <60 mL/min/1.73 m² measurements taken had no coding of CKD |
ADHD medication monitoring
BH
www.nice.org.uk/guidance/ng87 |
How many children and young people on stimulants for the treatment of ADHD have a recorded height, weight, blood pressure and pulse within the past 6 months? |
13% (1/8) of children aged <18 years taking stimulants had all four parameters recorded within the recommended time frame |
25% (4/16) of patients aged <20 years taking stimulants had all four parameters recorded within the recommended time frame |
Antibiotic treatment for women with a UTI
NF
www.nice.org.uk/guidance/ng109 |
What proportion of women with an uncomplicated UTI were prescribed a 3-day course of nitrofurantoin? |
74% (39/53) of women were given a 3-day course of antibiotics |
77% (17/22) of women were given a 3-day course of antibiotics |
| ADHD, attention deficit hyperactivity disorder; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; GDM, gestational diabetes mellitus; HbA1C, haemoglobin A1C; NICE, National Institute for Health and Care Excellence; UTI, urinary tract infection. |
All audits showed some improvement. The coding of CKD in patients with two consecutive measurements of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 showed the most change; only four patients had not been coded compared with 64 in the first audit. There was a small increase in both annual haemoglobin A1c (HbA1c) monitoring of women with a GDM history and in recording of all four parameters for patients on stimulants for ADHD. Subsequent discussion with the primary care team suggested these could be improved. There was little difference in the rate of three-day prescriptions for women with an uncomplicated UTI; the GPs said they sometimes prescribed longer courses of antibiotics for persistent symptoms, recurrent infection or patient preference.
Feedback of the generally positive findings improved the morale and motivation of the GPs. In addition, the practice was paid for hosting the students. Similarly, the students felt they were able to make a difference to clinical practice and to patients. All four medical students are now considering becoming GPs. We agree with Toukhsati et al1 that workplace initiatives, perhaps including protected time to teach and conduct audits, might help to address burnout.
Authors
Sara Kadhm, Medical Student, Population Health Research Institute, City St George’s, University of London, London, UK
Nabaha Fuad, Medical Student, Population Health Research Institute, City St George’s, University of London, London, UK
Rachel Hulme BA, MA, Medical Student, Population Health Research Institute, City St George’s, University of London, London, UK
Bushra Hasan, Medical Student, Population Health Research Institute, City St George’s, University of London, London, UK
Lakshmi Gribble FRACGP, General Practitioner, Winmalee Medical Centre, Blue Mountains, NSW
Pippa Oakeshott MA, MD, FRCP, FRCGP, Professor of General Practice, Population Health Research Institute, City St George’s, University of London, London, UK; General Practitioner, Dr Curran and Partners, Manor Health Centre, London, UK
Competing interests: None.
AI declaration: The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript.
Acknowledgements
The authors would like to extend our sincere gratitude to the staff and patients at the Curran practice, London, UK, with special thanks to deputy practice manager, Caroline Rafter.
References
- Toukhsati SR, Kippen R, Taylor C. Burnout and retention of general practice supervisors: Prevalence, risk factors and self-care. Aust J Gen Pract 2024;53(12) Suppl:S85–90. doi:10.31128/AJGP-11-23-7011.
- Beresford M, Weaver R, Stokes-Lampard H. General practice in an integrated NHS: Reasons to be hopeful. Future Healthc J 2023;10(3):178–80. doi: 10.7861/fhj.2023-0067.
- General Medical Council (GMC). Outcomes for graduates. GMC, 2018. Available at www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/outcomes-for-graduates/outcomes-for-graduates [Accessed 20 September 2024].
- Morrison JM, Sullivan FM. Audit: Teaching medical students in general practice. Med Educ 1993;27(6):495–502. doi: 10.1111/j.1365-2923.1993.tb00310.x.