Dear M. E. Voisin, 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

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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 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 forthis to happen Sadly, this lobbying is tending to fall on deaf ears,and workload, and in particular its intensity continues to rise, a5 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 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 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 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): 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 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 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 Responsibility at public level: A national discourse in media and politicians leading to CB negative views of GPs Lack of acknowledgement of issues NHS/primary care and that a national enquiry is required around suicide in health and care professionals 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 can practically reduce transferred workload. line and and facing they

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 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 the #LookingAfterYourTeam 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. We have a suite of wellbeing resources and webinars led by college members and available to all our members and fellows https [ LWWWICEDOrg_uklmembershiplgp-wellbeing These resources are all around GP wellbeing, emergency contacts and help lines The help_me Em 4 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 Signposting to wellbeing and mental health support via our website, including: 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 The Doctors" Support Network (DSN) is a peer support group for doctors with mental health problems HHP Wales is a face-to-face counselling service for all doctors in Wales provide doctors with access to accredited therapists in their area A healthcare professional who has experienced a significant personal or professional impact a5 a result of a patient safety incident can be referred to asa 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_ Sick Doctors Trust (SDD) provide a 24-hour confidential telephone helpline for doctors with drug and alcohol problems: Samaritans Doctors in Distress BMA Doctors 4 Doctors We provide through our President access bereavement group for any individual bereaved following the death of a health professional through suicide. 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 https { [WWwrcgp OrEukllearning-resources/primary-care_development /sudden-bereavement- support-pilot trust that this reply is helpful and if you have any questions please do not hesitate to contact me.