Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007–14

Hobbs, FD Richard; Bankhead, Clare; Mukhtar, Toqir K; Stevens, Sarah; Perera, Rafael; Holt, Tim; Salisbury, Chris

doi:10.1016/s0140-6736(16)00620-6

Cited by 510 publications

(508 citation statements)

References 7 publications

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“…9,12,13,18,19 A recently published quantitative study using the Clinical Practice Research Datalink (CPRD) found a 12% rise in GP consultation rates between 2007-2008 and 2013-2014, and an increase in the duration of consultations, contributing to an overall workload increase of 16%. 20 A British Medical Association focus group identified similar issues to those highlighted here, including a shift in care provision from secondary to primary care, increasing patient expectations and demands (with some GPs practising defensively), too much bureaucracy, and partnership being unattractive due to high workload and responsibility. 16 An online GP survey reported that 82% of participants intended to leave general practice, take a career break, and/or reduce clinical hours in the next 5 years, primarily due to workload intensity.…”

Section: Comparison With Existing Literaturementioning

confidence: 64%

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

2017

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BackgroundGPs report the lowest levels of morale among doctors, job satisfaction is low, and the GP workforce is diminishing. Workload is frequently cited as negatively impacting on commitment to a career in general practice, and many GPs report that their workload is unmanageable.AimTo gather an in-depth understanding of GPs’ perceptions and attitudes towards workload.Design and settingAll GPs working within NHS England were eligible. Advertisements were circulated via regional GP e-mail lists and national social media networks in June 2015. Of those GPs who responded, a maximum-variation sample was selected until data saturation was reached.MethodSemi-structured, qualitative interviews were conducted. Data were analysed thematically.ResultsIn total, 171 GPs responded, and 34 were included in this study. GPs described an increase in workload over recent years, with current working days being long and intense, raising concerns over the wellbeing of GPs and patients. Full-time partnership was generally not considered to be possible, and many participants felt workload was unsustainable, particularly given the diminishing workforce. Four major themes emerged to explain increased workload: increased patient needs and expectations; a changing relationship between primary and secondary care; bureaucracy and resources; and the balance of workload within a practice. Continuity of care was perceived as being eroded by changes in contracts and working patterns to deal with workload.ConclusionThis study highlights the urgent need to address perceived lack of investment and clinical capacity in general practice, and suggests that managing patient expectations around what primary care can deliver, and reducing bureaucracy, have become key issues, at least until capacity issues are resolved.

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Section: Comparison With Existing Literaturementioning

confidence: 64%

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

2017

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“…3 Workload for GPs has increased by 16% in the past 7 years, 4 while less than one in five UK Foundation Year 2 doctors went into general practice in 2015. 5 The patient population is growing faster than the GP workforce, with rising demands due to an ageing population and increase in multimorbidity.…”

Section: Introductionmentioning

confidence: 99%

Barriers, facilitators, and survival strategies for GPs seeking treatment for distress: a qualitative study

Spiers¹,

Buszewicz²,

Chew‐Graham

et al. 2017

Br J Gen Pract

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BackgroundGPs are under increasing pressure due to a lack of resources, a diminishing workforce, and rising patient demand. As a result, they may feel stressed, burnt out, anxious, or depressed.AimTo establish what might help or hinder GPs experiencing mental distress as they consider seeking help for their symptoms, and to explore potential survival strategies.Design and settingThe authors recruited 47 GP participants via e-mails to doctors attending a specialist service, adverts to local medical committees (LMCs) nationally and in GP publications, social media, and snowballing. Participants self-identified as either currently living with mental distress, returning to work following treatment, off sick or retired early as a result of mental distress, or without experience of mental distress. Interviews were conducted face to face or over the telephone.MethodTranscripts were uploaded to NVivo 11 and analysed using thematic analysis.ResultsBarriers and facilitators were related to work, stigma, and symptoms. Specifically, GPs discussed feeling a need to attend work, the stigma surrounding mental ill health, and issues around time, confidentiality, and privacy. Participants also reported difficulties accessing good-quality treatment. GPs also talked about cutting down or varying work content, or asserting boundaries to protect themselves.ConclusionSystemic changes, such as further information about specialist services designed to help GPs, are needed to support individual GPs and protect the profession from further damage.

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“…The specific types of training for HCPs that the experts thought would be most helpful and that HCPs would be most likely to actually participate in were individualized training in their offices and a clear and concise tutorial provided in the DHT itself. These results suggest that strategies that are most convenient and time-efficient, particularly given the ever increasing workload demands that HCPs encounter [34], are likely to be most feasible and effective for HCPs.…”

Section: Resources and Training For Hcps And Patientsmentioning

confidence: 91%

Expert Consensus Survey on Digital Health Tools for Patients With Serious Mental Illness: Optimizing for User Characteristics and User Support (Preprint)

Hatch¹,

Hoffman²,

Ross³

et al. 2018

Preprint

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Background: Digital technology is increasingly being used to enhance healthcare in various areas of medicine. In the area of serious mental illness (SMI), it is important to understand the special characteristics of target users that may influence motivation and competence to use digital health tools (DHTs), as well as the resources and training necessary for these patients to facilitate the use of this technology. Objective: To conduct a quantitative expert consensus survey to identify key characteristics of target users (patients and healthcare professionals [HCPs]), barriers and facilitators for appropriate use, and resources needed to optimize the use of DHTs in patients with SMI. Methods: A panel of 40 experts in digital behavioral health who met the participation criteria completed a 19-question survey rating predefined responses on a 9-point Likert scale. Consensus was determined using a chi-square test of score distributions across 3 ranges (1-3, 4-6, 7-9). Categorical ratings of first, second, or third line were designated based on the lowest category into which the confidence interval of the mean ratings fell, with a boundary >6.5 for first line. Here, we report experts' responses to 9 questions (265 options) that focused on (1) user characteristics that would promote or hinder the use of DHTs, (2) potential benefits/motivators and barriers/unintended consequences of DHT use, and (3) support and training for patients and HCPs. Results: Among patient characteristics most likely to promote use of DHTs, experts endorsed interest in using state-of-the-art technology, availability of necessary resources, good occupational functioning, and perception of the tool as beneficial. Certain diseaseassociated signs and symptoms (eg, more severe symptoms, substance abuse problems, a chaotic living situation) were considered likely to make it difficult for patients to use DHTs. Enthusiasm among HCPs for DHTs and availability of staff and equipment to support their use were identified as variables to enable HCPs to successfully incorporate DHTs into their practices. The experts identified a number of potential benefits of and barriers to use of DHTs by patients and HCPs. Most experts agreed that both HCPs and patients would need to be trained in the use of these new technologies. Conclusions: These results provide guidance to the mental health field on how to optimize the development and deployment of DHTs for patients with SMI.

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Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007–14

Cited by 510 publications

References 7 publications

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

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

Barriers, facilitators, and survival strategies for GPs seeking treatment for distress: a qualitative study

Expert Consensus Survey on Digital Health Tools for Patients With Serious Mental Illness: Optimizing for User Characteristics and User Support (Preprint)

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