Why do GPs leave direct patient care and what might help to retain them? A qualitative study of GPs in South West England

Abstract

ObjectiveTo identify factors influencing general practitioners’ (GPs’) decisions about whether or not to remain in direct patient care in general practice and what might help to retain them in that role.DesignQualitative, in-depth, individual interviews exploring factors related to GPs leaving, remaining in and returning to direct patient care.SettingSouth West England, UK.Participants41 GPs: 7 retired; 8 intending to take early retirement; 11 who were on or intending to take a career break; 9 aged under 50 years who had left or were intending to leave direct patient care and 6 who were not intending to leave or to take a career break. Plus 19 stakeholders from a range of primary care-related professional organisations and roles.ResultsReasons for leaving direct patient care were complex and based on a range of job-related and individual factors. Three key themes underpinned the interviewed GPs’ thinking and rationale: issues relating to their personal and professional identity and the perceived value of general practice-based care within the healthcare system; concerns regarding fear and risk, for example, in respect of medical litigation and managing administrative challenges within the context of increasingly complex care pathways and environments; and issues around choice and volition in respect of personal social, financial, domestic and professional considerations. These themes provide increased understanding of the lived experiences of working in today’s National Health Service for this group of GPs.ConclusionFuture policies and strategies aimed at retaining GPs in direct patient care should clarify the role and expectations of general practice and align with GPs’ perception of their own roles and identity; demonstrate to GPs that they are valued and listened to in planning delivery of the UK healthcare; target GPs’ concerns regarding fear and risk, seeking to reduce these to manageable levels and give GPs viable options to support them to remain in direct patient care.

Workforce predictive risk modelling: development of a model to identify general practices at risk of a supply−demand imbalance

“…This reduction has been seen in combination with rising demands of the patient population 2. Such figures represent a ‘crisis’ in respect of GP workforce capacity, with particular problems in retaining established GPs in direct patient care 3 4. Similar problems in respect of family doctor recruitment and retention are evident in other western healthcare economies and jurisdictions,5 6 and many countries have explored what might constitute optimal skill mix among primary care health professionals over the last 40 years 7–9…”

“…There is, however, a need for the rational deployment of the GP workforce resource 10 11. Various models exist to inform that deployment, with GP workload representing a key issue among individual GPs electing to quit patient care 3. Gaining an understanding of GP workload pressures is also the basis of identifying any potential mismatch between the demand for general practice services and the supply of GPs to meet that demand.…”

A “Deep Breath In” for GPs

“…And yet, the essential role(s) of a GP and the expectations patients had of us were already in flux 5. A qualitative study of GPs in southwest England from 2018 found that a lack of personal-professional boundaries and “unrealistic expectations about what general practice can and should deliver” were key reasons why GPs left their clinical practice 6. As covid-19 stresses the already flimsy boundary between our personal and professional lives, GPs are questioning the part we play in our health systems while confronting the fear, anxiety, and uncertainty of practising in the time of covid-19.…”

GPs: working harder than ever

“…3 Workload is consistently identified as a key reason underpinning the current exodus of many GPs from direct clinical care. 4 Promises of more GPs made by NHS England, along with £2.4 billion in extra funding for general practice, are welcome. 5 But progress addressing workforce issues has been slower than anticipated, and major issues in the recruitment and retention of GPs persist.…”