Written evidence submitted by Dr Jeremy Ferguson MB ChB MRCP FRCS Ed MRCGP Cert Med Ed Dip Med Ed (FGP0157)


I gained my Medical Degree at the University of Bristol 1979.

I worked full time as a GP partner for 30 years, until the age of 60.

Since 2016 I have continued to work, 5 sessions a week as a salaried GP.

I have a been a GP appraiser since 2003, during this time I have become aware of many doctors suffering from poor work-life balance and burnout.


What can be done to reduce bureaucracy and burnout, and improve morale, in general practice.

In 2017, I started an MA in Medical Education, at the University of Winchester, which encouraged critical reflection of my appraiser work and researching my own practice.

I had discovered many GPs suffering from stress, overwork, signs of burnout and neglect of their own health. When asked to write an assignment on ‘an issue drawn from your appraisal practice’, I was confronted by the uncomfortable feeling, Could I have done more, rather than just flag up suggestions of making changes and seek support.

I wrote a Work-Life Balance (WLB) quiz, and encouraged by the feedback ‘should be offered to all appraisees’, I was able to persuade the Wessex Appraisal Service to support the idea, for inclusion on the FourteenFish Appraisal Portfolio, which was widely used in Wessex.

In the first year the WLB assessment was used by 2602 GPs (49% uptake)

The conclusions and implications for practice, from using the WLB assessment are


  1. 88% of GPs have found the WLB assessment useful for reflection. This should be extended to all doctors.
  2. GP Health and Wellbeing should be discussed in appraisal, beyond the requirements of the health declaration.
  3. 54% of GPs have significant ‘Work-overload risking burnout’ (27.7 % frequently + 26.3% a great deal = 54 %). Until this is resolved, there will be problems with                           recruitment, more part-time work, and early retirement.

Ferguson, J, Scallan, S., Lyon-Maris, J., and Ball, K. (2019) The impact of a Work-life Balance (WLB) assessment on doctors’ continuing professional development and performance. In: RCGP Annual Conference. Poster Presentation. No: 449. Available at: https://www.rcgpac.org.uk/programme-overview/posters-abstracts-2019/.



Consequences of poor WLB and Burnout

              The consequences are not just for doctors’ poor health with time off sick and early retirement, but it impacts on patients with suboptimal care and healthcare costs are increased too.  

West, C. P., Dyrbye, L. N., and Shanafelt, T. D. (2018) Physician burnout: contributors, consequences and solutions. Journal of Internal Medicine 283, (6) 516–529. https://doi.org/10.1111/joim.12752

Strategies to improve WLB and Burnout

              The NHS has expected doctors to be responsible for their own health and wellbeing.

But as organisations are becoming aware of the consequences of poor WLB they are being forced to find solutions, such as stress management and resilience workshops focusing on this being a personal problem, but this neglects the wider issues. A metanalysis by Panagioti found that Individual interventions - mindfulness to enhance competence, improving communication and personal coping strategies, the benefits were small; and Organisation interventionschanges in schedule, reductions in intensity of workload- these were more effective, but these interventions were rare.

Panagioti, M., Panagopoulou, E., Bower, P., Lewith, G., Kontopantelis, E., Chew-Graham, C., Dawson, S., van Marwijk, H., Geraghty, K., and Esmail, A. (2017) Controlled Interventions to Reduce Burnout in Physicians. JAMA Internal Medicine 177, (2) 195. https://doi.org/10.1001/jamainternmed.2016.7674

              The Mayo Clinic Program ‘Listen, Act, Develop was developed as an integrated strategy to improve wellbeing, reduce burnout, maximise satisfaction and meaning at work and engage everyone in the effectiveness of the organisation, with nine strategies

Swensen, S., Kabcenell, A., and Shanafelt, T. (2016) Physician-organization collaboration reduces physician burnout and promotes engagement: The mayo clinic experience. Journal of Healthcare Management 61, (2) 105–127

I wrote an article in the British Journal of General Practice ‘Exploring work-life balance at appraisal and how this links with organisational support’, this examined the Mayo Clinic program nine steps, and what we could learn from them for NHS general practice.


Ferguson, J., Scallan, S., Lyons-Maris, J., and Ball, K. (2020) Exploring ‘work-life balance’ at appraisal and how this links with organisational support. The British journal of general practice : the journal of the Royal College of General Practitioners 70, (697) 411–412. https://doi.org/10.3399/bjgp20X712109

1 Acknowledge and assess the problem

The WLB assessment is a step towards this, it is popular, cost minimal, and could be extended to all GPs.

2 Harness power of leadership

GPs set an important example in promoting wellbeing to everyone around them, and this has been shown to be more effective for advising lifestyle advice to patients.

3 Develop and implement targeted interventions

Reviewing roles and delegating tasks allows more time for patient care. I have seen the benefits of paramedics doing all home visiting, and a pharmacist in the surgery dealing with medication requests. But GPs are still overwhelmed by the tasks and letters, which take time accessing patient records and then discussing with patients.

4 Cultivate community at work

Peer support is vital for dealing with the pressures and complaints that are more commonplace for GPs. Meetings and informal coffee breaks enhance teamworking and professional relationships, but when practices are under pressure these meetings are dropped with a knock-on decline in morale.

5 Use rewards and incentives wisely

Flexible working and good WLB are important considerations to encourage doctors to become GPs, with opportunities for professional development in education, research and leadership. But incentives are important throughout careers to live healthily and defer early retirement through reducing work intensity.

6 Align values and strengthen culture

Organisations that promote health and wellbeing for their workforce gain loyalty, which brings benefits to patients too.

7 Promote flexibility and Work-life integration

Doctors work is stressful, flexibility is important to fit with family commitments. This is important to attract and retain staff in the NHS.

8 Provide resources to promote resilience and self-care

The NHS needs to promote WLB for all doctors, leading to better patient care and reduced healthcare costs. But needs to be seen, as part of the Organisational responsibility to ensure workload is safe. At present many GPs after seeing patients in the surgery and phone consultations then have to deal with many tasks, letters and e-consults, spending 12 hours a day at work. This is unsustainable leading to burnout.

9 Facilitate research and support for doctors wellbeing

The Mayo clinic program has reduced burnout from 48.8% to 32.9%. The WLB assessment at appraisal is a step forwards in raising awareness. Since it was introduced 3 years ago the message has been taken up by GP appraisers across the country to ask about WLB. But more research needs to be done to gather WLB results from all doctors to guide work planning and resources.


I trust this information will inform your deliberations.

Yours sincerely

Jeremy Ferguson


Dec 2021