Susan Carling

-

Department 
of Health & 
Social Care 

M.  E.  Voisin 
Senior Coroner 
The Coroner's Court 
Old Western  Road 
Flax Bourton 
BS48  1UL 

Dear M.  E.  Voisin, 

From Maria  Caulfield MP 
Parliamentary Under Secretary of State 
Department of Health  and Social Care

39  Victoria  Street
London 
SW1H0EU

g,h  January 2023 

Thank you  for your  letter of 28  April  2022  about the  death  of Susan  Elizabeth  Carling.  I am 
replying  as  Minister with  responsibility for Mental Health and the Women's Health  Strategy. 

Firstly,  I would  like to  say  how deeply  saddened  I was to  read  of Ms  Carling's  death.  I can 
appreciate  how distressing  her death  must be  for  her family  and  those  who  knew  her  and  I 
offer my  heartfelt  condolences.  It  is  vital that we  take the  learnings  from  what  happened  to 
prevent future deaths. 

In  preparing this response,  Departmental officials have made enquiries with NHS England and 
the Royal  College of General Practitioners. 

As you indicated in your report,  one way in which health care workers are supported is through 
Practitioner Health.  This is a free,  confidential  NHS  primary care  mental health and  addiction 
service with expertise specifically treating health and care professionals.  The service can help 
with  a range  of mental  health  conditions  and  addictions  in  primary  care  settings.  They  also 
see  healthcare  professionals with  more  severe  illnesses,  such  as  bipolar  affective  disorder, 
personality disorders and  psychosis and with a range  of addiction  issues. 

The service exists for the  special  needs  of healthcare professionals with  mental  illness,  how 
their role  might impact on  their ability to seek out help,  and  how their condition  might impact 
on  their work and  potentially their own  patients.  The service  providers  are skilled  at helping 
health  professionals  with  their  mental  health  whilst  returning  to  work  or  training.  Crucially, 
they work in the unique interface between health practitioners as  regulated  professionals and 
as patients with a mental illness,  and  as such are experts at the interface between regulation, 
employment and mental illness and  addiction.  Furthermore, the service is a multidisciplinary, 
integrated  team,  drawing  together  General  Practitioners  (GPs),  psychiatrists,  nurses  and 
therapists  into  a single  network with  shared  objectives,  jointly caring  for their  patients.  They 
have  clinicians  available  across  England  offering  a  hybrid  mix  of  face  to  face  and  virtual 
consultations. 

In  response to your concerns regarding  the  need to  highlight the help available for GPs,  NHS 
England,  in  collaboration  with  the  Royal  College  of General  Practitioners,  has  launched  the 
#LookingAfterYouToo  and  the  #LookingAfterYourTeam  coaching  support  services.  These 

 
 services provide access to  mental health services for all  primary care workers, managers and 
leaders  employed  or  contracted  to  deliver  work  on  behalf of the  NHS.  This  is  available  in 
addition  to  Practitioner  Health.  Further  to  this,  the  Royal  College  of General  Practitioners 
signposts  to  wellbeing  and  mental  health  support  on  their  website,  including  Practitioner 
Health, the Doctors' Support Network and the Sick Doctors Trust, amongst others.  The Royal 
College  also  held  a  stakeholder  event  in  November  2022,  in  partnership  with  Doctors  in 
Distress  and  Practitioner  Health,  to  highlight  the  issue  of  suicide  and  to  drive  discussions 
towards potential solutions. 

In  addition,  an  area  for action  in  the  national  suicide  prevention  strategy,  Preventing  suicide 
in  England:  a cross-government outcomes strategy to  save lives (2012),  is to reduce the risk 
of suicide in  key high-risk groups, which includes specific occupational groups such  as doctors 
and nurses. 

The  Government  also  launched  a  public  call  for  evidence  on  what  can  be  done  across 
government in the longer term to support mental health, wellbeing and suicide prevention.  The 
call  for  evidence  closed  on  7  July  2022  and  we  are  currently  analysing  the  over  5,000 
responses that received. 

More  generally,  we  are  investing  an  additional  £57million  in  suicide  prevention  by  2023/24 
through the NHS Long Term Plan.  Through this, all areas of the country are seeing investment 
to  support  local  suicide  prevention  plans  and  the  development  of  suicide  bereavement 
services. 

We  also  awarded  113  charities  a  share  of £5.4million  grant  funding  in  2021/22  to  prevent 
suicide  in  high-risk groups.  This funding  was distributed to  the  suicide  prevention  voluntary, 
community and  social enterprises to support service delivery. 

Finally, over £45 million has been invested in 2022/23 to support the continuation of the health 
and  wellbeing  support  offer  for  healthcare  staff,  which  includes  the  40  mental  health  hubs 
across the country that provide outreach  and  assessment services.  This helps frontline  staff 
receive  rapid  access  to  evidence-based  mental  health  services.  NHS  England  continue  to 
develop  tailored  health  and  wellbeing  offers  that  meet  the  needs  of their  local  workforce, 
especially  through  the  Mental  Health  Hubs  in  each  Integrated  Care  System  and  through 
occupational  health  services  that  are  being  supported  through  the  national  Growing 
Occupational Health and Wellbeing  programme. 

I hope this response is  helpful. Thank you for bringing these concerns to  my attention. 

Kind  regards, 

MARIA CAULFIELD

RC Royal College of
G P General Practitioners

ME Voisin
Senior Coroner - Area of Avon

14 December 2022

Dear Ms Voisin

Regulation 28 Report to Prevent Future Deaths - touching on the death of Susan Elizabeth
Carling

Thank you for your letter of 28 April 2022. | am responding on behalf of the Royal College of
General Practitioners as Honorary Secretary to Council. Firstly, can | convey our sincere
condolences to the family and friends of Dr Carling, | was deeply saddened to read of Dr
Carling’s death.

The Royal College of General Practitioners (RCGP) is the largest membership organisation in the
United Kingdom solely for GPs. It aims to encourage and maintain the highest standards of
general medical practice and to act as the ‘voice’ of GPs on issues concerned with education;
training; research; and clinical standards. Founded in 1952, the RCGP has just over 54,000
members who are committed to improving patient care, developing their own skills and
promoting general practice as a discipline.

We are aware at the RCGP of the tragic loss of life through suicide of Doctors and are actively
engaged as a College and particularly, through the charities and services founded by our
President Professor [BEE who is a national expert in the support of Doctors with
mental health illnesses, on the issue of suicide and working to help reduce the risk and
prevalence.

To answer your question, | have turned to her for specific advice and her response is below:

Thank you for asking RCGP respond to your request. The issue of suicide amongst health
professionals is one close to the RCGP’s heart. The rate of mental illness amongst doctors is at
least as high, if not higher than an aged, matched population. This despite doctors having a host of
protective factors which should prevent ill health (secure employment, well paid jobs, social
networks, high status job). With respect to suicide amongst doctors, the literature is very confusing

with respect to rate of suicide. Overall, and taking the literature as it is, male doctors have around
the same, if not slightly lower rates of suicide than the general population. Women doctors on the
other hand have between 2-5 times the rate of suicide compared to an aged, matched population
and unlike any other group, have suicide rates equal to men (in all other spheres men are higher).
The high rates of suicide are multifactorial.

Within the medical profession, GPs are currently most at risk from suicide and in essence working
in front line general practice must be now seen as a major risk factor for suicide. Any action to
reduce the workload should also be seen as supportive, and the College has been lobbying on
behalf of all GPs for this to happen. Sadly, this lobbying is tending to fall on deaf ears, and workload,
and in particular its intensity continues to rise, as does the high levels of suicidal thoughts, and
number of complete suicides.

It is important that whilst you have asked us, that is the RCGP as to what is being done to support
our colleagues, that suicide amongst doctors needs a collective approach towards prevention with
policy makers, politicians and professional bodies all involved in reducing this needless loss of life.

The RCGP agrees that urgent action is needed to reduce the rate of suicide amongst all health
professionals. The College held a high-level stakeholder event in partnership with Doctors in
Distress and Practitioner Health in November 2022 to highlight the issue (of suicide) amongst
those who can effect change and to drive discussions towards stakeholder (system wide) potential
solutions.

The group identified key issues affecting GPs though these issues are universal as risk factors, the
only difference being the level of the risk. The main issues relate to unsustainable and intolerable
workload and for GPs coupled with negative press and constant unfair blame directed at them.
The group also noted that there has been little recognition of impact and toll of the pandemic on
mental health of workforce and that as we emerge from it, staff numbers have gone down whilst
patient demand up.

The College has identified different tiers of responsibilities where action must happen.
These are (and briefly):
1. Responsibility at individual level: Many GPs and other clinicians do not allow themselves

the time and space to take care of their own needs and become unwell as a result. In worst
cases this can result in suicidal attempts or death.

N

Responsibility at organisational/local level; to address the mismatch between workload
(demand) and need, leading to pressure on those working within the system coupled with
the lack of space and time to problem solve

tad

Responsibility at national/political level: to address commissioning/contracting issues
which now result in lack of autonomy for practices. Lack of plan to deal with workforce
issues and to change direction of workload flow into primary care

4. Responsibility at public level: A national discourse in media and politicians leading to
negative views of GPs. Lack of acknowledgement of issues facing NHS/primary care and
that a national enquiry is required around suicide in health and care professionals.

5. Responsibility at professional level: To ensure that Royal Colleges and others who
represent the profession provide access to safe, effective, and timely support and
information as needed. Included in this is that there is a responsibility to create a shift in
thinking to that primary care can ‘do it all’ and reduce the expectations placed on this over
stretched professional group. This requires other specialities to assess how they can
practically reduce transferred workload.

With respect to the RCGP and what are we specifically doing:

The RCGP provides a suite of support to all its members and fellows. Specifically

1. We provide all new members with the details of existing support services, at the time they
become members.

2 NHS England and Improvement, in collaboration with the RCGP has launched the
“#LookingAfterYouToo and the #LookingAfterYourT eam coaching support services. These
services provide access to mental health services to all primary care workers, managers
and leaders employed or contracted to deliver work on behalf of the NHS.

3. We have a suite of wellbeing resources and webinars led by college members and available
to all our members and fellows. https://www_rcgp.org.uk/membershi -wellbein:
These resources are all around GP wellbeing, emergency contacts and help lines.

The help me. I'm a doctor site brings together five independent charities that support
doctors when they need confidential financial assistance. They can provide support to help
doctors in genuine financial need get their lives and careers back on track.

4. Signposting to wellbeing and mental health support via our website, including:

e Practitioner Health The NHS Practitioner Health Programme is an award winning,
free and confidential NHS service for doctors and dentists with issues relating to a
mental or physical health concern or addiction problem, especially when it might
affect their work.

e The Doctors’ Support Network (DSN) is a peer support group for doctors with
mental health problems.

e HHP Wales is a face-to-face counselling service for all doctors in Wales. They
provide doctors with access to accredited therapists in their area. A healthcare
professional who has experienced a significant personal or professional impact as
a result of a patient safety incident can be referred to as a second victim. This web-
based resource provides guidance and tools to support individuals (and their
managers) who have experience of being involved in such incidents.

e Sick Doctors Trust (SDT) provide a 24-hour confidential telephone helpline for
doctors with drug and alcohol problems.

e Samaritans

e Doctors in Distress

e BMA Doctors 4 Doctors

5. We provide, through our President access to a bereavement group for any individual
bereaved following the death of a health professional through suicide.

6. We collaborate with other stakeholders such as Doctors in Distress, Academy Medical
Royal Colleges, General Medical Councill, Practitioner Health to reduce the rate of suicide.

The RCGP also recognises the impact the sudden death of a colleague on the wellbeing of the
remaining practice team and have recently introduced through our professional development
team a pilot project supporting those team affected.

support-pilot

| trust that this reply is helpful and if you have any questions, please do not hesitate to contact
me.

Yours sincerely

RCGP Honorary Secretary