Policies and strategies to retain and support the return of experienced GPs in direct patient care: the ReGROUP mixed-methods study

Abstract

BackgroundUK general practice faces a workforce crisis, with general practitioner (GP) shortages, organisational change, substantial pressures across the whole health-care system and an ageing population with increasingly complex health needs. GPs require lengthy training, so retaining the existing workforce is urgent and important.Objectives(1) To identify the key policies and strategies that might (i) facilitate the retention of experienced GPs in direct patient care or (ii) support the return of GPs following a career break. (2) To consider the feasibility of potentially implementing those policies and strategies.DesignThis was a comprehensive, mixed-methods study.SettingThis study took place in primary care in England.ParticipantsGeneral practitioners registered in south-west England were surveyed. Interviews were with purposively selected GPs and primary care stakeholders. A RAND/UCLA Appropriateness Method (RAM) panel comprised GP partners and GPs working in national stakeholder organisations. Stakeholder consultations included representatives from regional and national groups.Main outcome measuresSystematic review – factors affecting GPs’ decisions to quit and to take career breaks. Survey – proportion of GPs likely to quit, to take career breaks or to reduce hours spent in patient care within 5 years of being surveyed. Interviews – themes relating to GPs’ decision-making. RAM – a set of policies and strategies to support retention, assessed as ‘appropriate’ and ‘feasible’. Predictive risk modelling – predictive model to identify practices in south-west England at risk of workforce undersupply within 5 years. Stakeholder consultation – comments and key actions regarding implementing emergent policies and strategies from the research.ResultsPast research identified four job-related ‘push’ factors associated with leaving general practice: (1) workload, (2) job dissatisfaction, (3) work-related stress and (4) work–life balance. The survey, returned by 2248 out of 3370 GPs (67%) in the south-west of England, identified a high likelihood of quitting (37%), taking a career break (36%) or reducing hours (57%) within 5 years. Interviews highlighted three drivers of leaving general practice: (1) professional identity and value of the GP role, (2) fear and risk associated with service delivery and (3) career choices. The RAM panel deemed 24 out of 54 retention policies and strategies to be ‘appropriate’, with most also considered ‘feasible’, including identification of and targeted support for practices ‘at risk’ of workforce undersupply and the provision of formal career options for GPs wishing to undertake portfolio roles. Practices at highest risk of workforce undersupply within 5 years are those that have larger patient list sizes, employ more nurses, serve more deprived and younger populations, or have poor patient experience ratings. Actions for national organisations with an interest in workforce planning were identified. These included collection of data on the current scope of GPs’ portfolio roles, and the need for formal career pathways for key primary care professionals, such as practice managers.LimitationsThe survey, qualitative research and modelling were conducted in one UK region. The research took place within a rapidly changing policy environment, providing a challenge in informing emergent policy and practice.ConclusionsThis research identifies the basis for current concerns regarding UK GP workforce capacity, drawing on experiences in south-west England. Policies and strategies identified by expert stakeholders after considering these findings are likely to be of relevance in addressing GP retention in the UK. Collaborative, multidisciplinary research partnerships should investigate the effects of rolling out some of the policies and strategies described in this report.Study registrationThis study is registered as PROSPERO CRD42016033876 and UKCRN ID number 20700.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Understanding why primary care doctors leave direct patient care: a systematic review of qualitative research

“…As described in detail previously, 1 general practice in the UK is facing a workforce 'crisis', in part due to so many general practitioners (GPs) leaving direct patient care, or reducing their hours, and many others intending to do so. 2 While this is a problem being experienced in a number of high-income countries, a report by the Commonwealth Fund in 2015 showed the problem for UK general practice is particularly serious, with nearly 30% of GPs planning to leave general practice within 5 years.…”

Developing Interprofessional Primary Care Teams: Alumni Evaluation of the Department of Veterans Affairs Centers of Excellence in Primary Care Education Program

“…However, to work effectively in these complex environments providers must possess interpersonal and technical skills to work effectively on interprofessional teams while maintaining professional identity and providing safe high quality care. 22 Our findings suggest ways to increase the appeal of primary care practice for trainees across all health professions, generally falling into the following 3 categories: (1) increasing the value of team-based care delivery to providers through interprofessional education, (2) improving the interprofessional clinical learning environments where providers practice, and (3) expanding efforts to transition new graduates to these environments. With respect to the first category, we found that all professions valued team-based practice that could make them more effective providers.…”

Identifying policies and strategies for general practitioner retention in direct patient care in the United Kingdom: a RAND/UCLA appropriateness method panel study

“…Three sources of information were used to develop policies and strategies for panel consideration: (1) research evidence from systematic reviews and key reports; (2) UK policy documents relating to GP recruitment and retention reported by NHS England, the BMA, and the RCGP; and (3) the emergent findings from the ReGROUP systematic review [7] and qualitative studies [14]. The selected papers, reports and policy developments were summarised into a short evidence briefing paper for consideration by the panellists (Additional file 1).…”

“…A systematic review of qualitative and quantitative evidence was undertaken as part of the ReGROUP project in order to summarise the factors related to GPs quitting and/or intending to quit patient care [7]. This review identified a number of ‘push’ and ‘pull’ factors which influenced decisions to reduce hours or leave direct patient care.…”

“…The present study was part of the mixed methods ReGROUP project [7], with earlier work streams including a systematic literature review and qualitative interview study [14]. Here we report the findings of a panel consensus study, the aim of which was to identify policies and strategies that might be potentially appropriate at facilitating the retention of GPs in direct patient care in the UK.…”