Experience of contractual change in UK general practice: a qualitative study of salaried GPs

Abstract

BackgroundGeneral practice in the UK underwent major change in 2004, with the introduction of new contracts and a significant element of pay for performance. Although salaried GPs form an increasing proportion of the general practice workforce, little is known of their experiences. AimTo explore the views and experiences of salaried GPs working in English general practice. Design and settingQualitative study using semi-structured interviews in 17 practices across England, between July 2007 and September 2009. MethodInterviews were conducted with 23 salaried GPs. A topic guide included questions on motivations for a career in general practice, descriptions of their daily working environment and duties, practice relationships, and future aspirations. ResultsThe new ability to opt out of out-of-hours responsibilities was deemed positive for the profession but not a major driver for choosing medical speciality. Views regarding the impact of the Quality and Outcomes Framework were ambivalent. Differences in pay were regarded as largely reflective of differences in responsibility between salaried GPs and principals. Most participants reported conducting varied work in collaborative practices. Participants held varying career aspirations. ConclusionSalaried GPs' working experiences were dependent upon personal aspirations and local context. Most salaried GPs were reportedly content with their current position but many also had aspirations of eventually attaining GP principal status. The current lack of available partnerships threatens to undo recent positive workforce progress and may lead to deep dissatisfaction within the profession and a future workforce crisis. Further large-scale quantitative work is required to assess the satisfaction and future expectations of those in salaried posts. Keywordsgeneral practice; primary care; workforce.

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“…This has been shown to increase utilisation in medicine. 14,102,103 Among DCPs themselves, a number of day-to-day barriers were found to reduce the efficiency of working in the practice environment. These included not being able to prescribe fluoride varnish and the inability to prescribe local analgesia when they were asked to carry out more interventional treatments.…”

Health Care Professionals’ Perceptions of Pay-for-Performance in Practice: A Qualitative Metasynthesis

“…The negative consequences of P4P on health equity were addressed in multiple studies. 35,40,45,52,58 A key concern was the credibility of the quality targets and relevance across populations. Some industry members said that clinics with more resources can put more toward necessary clinic redesign, which leads to success with P4P.…”

“…Several studies noted that P4P disrupts patient-centered care, contributes to a loss of holism and continuity, and disrupts the doctor-patient relationship. 34,35,[38][39][40][42][43][44][45][46][47][48]52 Numerous study participants noted exacerbated tensions during patient consultations as well as a decreased focus on patient concerns and less continuity of care. Many P4P programs incentivize sameday appointments and after-work hours to ensure access but that might mean that patients work with multiple providers.…”

“…34 The redistribution of work from doctors to nurses, who were given expanded roles and autonomy was noted by many study participants. 34,35,[38][39][40]42 The introduction of P4P programs created opportunities to delegate responsibility for chronic care management and monitoring of the tests, tools, and questionnaires necessary for success with performance measurement. Nurses reported their expanded role led to increased continuity for patients as well as increased role autonomy, and increased workload and stress.…”