Guest blog by Dr Rebecca Torry and Dr Alex Freeman, The Louise Tebboth Foundation
When a member of a primary care team dies suddenly, there are considerable repercussions. About thirty people will work directly with the person who has died. Primary care teams are often part of a larger group with several sites. People will know each other, and some will have forged close relationships. The practice will be part of a primary care network (PCN) and a clinical commissioning group (CCG). Doctors (and sometimes others) may have additional roles as trainers, appraisers or working with the CCG. Any staff member may have worked in other places in the recent past. There will be those they trained with and those who knew them earlier in their careers. All will be affected by the death to a greater or lesser extent. Patients as well as colleagues will be bereft. It is not only doctors and nurses who are well known to patients. It is certainly true of receptionists. If a death is by suicide, the emotional impact is huge, and the whole team can be destabilized.
Those closest to the person who has died can also be those who must manage the situation and support the rest of the team. Those who carry professional responsibility also employ the staff and have a significant management role, even if they also employ a manager. This is something which general medical practitioners have in common with other professionals who work in partnership, including veterinary practitioners, lawyers, and dentists. These professions are all associated with an above average risk of death by suicide. The numbers may be small, but the effects can be considerable, both immediately and into the future.
Primary health care teams lack external management support. There is limited access to occupational health input. Arranging cover for bereavement related absence is the responsibility of the practice. CCGs have a duty of care which is primarily to patients rather than to practices. There is little written to help a practice or partnership handle the death by suicide of one of its team. Most of the published guidelines on how to manage a death by suicide assume a management structure beyond the team which the death has impacted. Just how do they cope, what support is needed and when, and how can they access the right support at the right time?
Considering this question led The Louise Tebboth Foundation[1] to commission research on the impact of the death by suicide of a colleague in a primary care setting, with the aim of producing a suicide postvention framework. The term ‘suicide postvention’ refers to the actions taken within an organisation to provide support after a death by suicide in an effective and sensitive way. The framework was based on interviews and discussions with those who have been directly affected and has now been published[2].
What was revealed was how difficult it was to access the right kind of support or even know what kind of support would or should be available. One of our interviewees described the event as a major incident for which all practices should have a plan. The framework sets out the actions needed during the first day, the first week, the first month and the first year after a death by suicide and could form the basis for such a plan.
It may be helpful to highlight a couple of the key recommendations.
The study showed that it was usual for a practice to be required to remain open for patient care while a staff member's funeral was taking place. This was a source of substantial distress to those unable to attend and would be the case whatever the cause of a sudden death. It would apply following deaths from COVID-19. Practices who make a request to close so that staff can attend the funeral of a colleague should be allowed to do so. There is a need for the creation of a single point of contact for a bereaved practice. Someone external needs to be available, to advocate for the practice and help them resolve immediate practical issues and ensure that all staff have access to appropriate support immediately and over the first months.
As Sir David Haslam said at the launch of the paper[3]
"It would make absolute sense for support to be made available wherever and whenever there has been a sudden bereavement – whatever the reason. It might be too much to expect that each and every CCG or local area will develop such expertise, which perhaps makes it more logical for national or regional teams to take this on – to be an identifiable and expert source of guidance and support."
It is anticipated that this report will help practices when the unthinkable happens, and will also assist policy makers, commissioners, representatives and supporting organisations in planning the kind of support that they could and should be offering.
Dr Rebecca Torry MB BChir MMedEd FRCGP is a Trustee of The Louise Tebboth Foundation and GP at Nexus Health Group. Dr Alex Freeman BM MPH MRCGP is Chair of The Louise Tebboth Foundation and GP Partner at Living Well Partnership.
[1] The Louise Tebboth Foundation aims to provide financial assistance to projects and services which support the mental wellbeing of doctors in England and Wales and initiatives assisting the bereaved families of doctors who have died by suicide. Visit the website at: www.louisetebboth.org.uk