Retaining the general practitioner workforce in England: what matters to GPs? A cross-sectional study

Abstract

BackgroundThe general practice (GP) workforce in England is in crisis, reflected in increasing rates of early retirement and intentions to reduce hours of working. This study aimed to investigate underlying factors and how these might be mitigated.MethodsGPs in central England were invited to participate in an on-line survey exploring career plans and views and experiences of work-related pressures. Quantitative data were analysed using logistic regression analysis and principal components analysis. Qualitative data were analysed using a thematic framework approach.ResultsOf 1,192 GPs who participated, 978 (82.0 %) stated that they intend to leave general practice, take a career break and/or reduce clinical hours of work within the next five years. This included 488 (41.9 %) who intend to leave practice, and almost a quarter (279; 23.2 %) intending to take a career break. Only 67 (5.6 %) planned to increase their hours of clinical work.For participants planning to leave practice, the issues that most influenced intentions were volume and intensity of workload, time spent on “unimportant tasks”, introduction of seven-day working and lack of job satisfaction.Four hundred fifty five participants responded to open questions (39128 words in total). The main themes were the cumulative impact of work-related pressures, the changing and growing nature of the workload, and the consequent stress.Reducing workload intensity, workload volume, administrative activities, with increased time for patient care, no out-of-hour commitments, more flexible working conditions and greater clinical autonomy were identified as the most important requirements to address the workforce crisis. In addition, incentive payments, increased pay and protected time for education and training were also rated as important.ConclusionsNew models of professionalism and organisational arrangements may be needed to address the issues described here. Without urgent action, the GP workforce crisis in England seems set to worsen.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0363-1) contains supplementary material, which is available to authorized users.

GPs’ perceptions of workload in England: a qualitative interview study

“…Similar themes to those in the present study arose, including increased patient expectations, recruitment and retention difficulties, burgeoning administration and bureaucracy, transfer of work from secondary care, and the introduction of 7-day working. 21 The latter concern was raised by some GPs in the present study, perhaps because the '7-day NHS' formed part of the government's election campaign shortly before the interviews were conducted. 22 A recent mixed methods study exploring why so many GPs in England leave practice before the age of 50 also found that increased workloaddue in part to increased bureaucracy, the shift of work from secondary care to primary care, a change in patient demands, and time pressures -is a major contributor.…”

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“…13 There is evidence to show that increased work stress and work intensity leads GPs under 'high strain' to report higher levels of anxiety, depression, and dissatisfaction than GPs under 'low strain', and that the health impacts of stress continued outside of work, which in turn could increase job dissatisfaction and intention to quit the profession. 43,44 Job satisfaction is also influenced by expectations about future events. 45 If doctors perceive that their workload will not reduce, and that demands will always increase, it is likely that they will feel more overwhelmed and less satisfied with their job, and thus more likely to quit.…”

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