Abstract
BackgroundThere is a GP workforce crisis, particularly in areas of high socioeconomic deprivation where levels of multimorbidity and social complexity are higher than in areas of low socioeconomic deprivation. How this impacts GP work, and how GPs manage workload has not been fully explored.AimTo explore GP work in areas of high socioeconomic deprivation and the strategies GPs employ, using Corbin and Strauss’s framework on managing chronic illness as an analytical lens.Design & settingSecondary analysis of qualitative in-depth interviews with GPs working with populations experiencing high levels of socioeconomic deprivation.MethodSecondary analysis of in-depth interviews with GPs working in areas of high socioeconomic deprivation (n = 10).ResultsAll three types of work defined by Corbin and Strauss (everyday, illness, and biographical) were described, and one additional type: emotional (work managing GPs’ own emotions). The context of socioeconomic deprivation, increased multimorbidity plus social complexity (’multimorbidity plus’), influenced GP work. Healthcare systems and self-management strategies did not meet patients’ needs, which meant the resulting gap created extra everyday work, often unrecognised (which was a source of frustration). GPs also described taking on ’illness work’ for patients who were either overwhelmed or unable to do it. Some GPs described biographical work, asserting their professional role against demands from patients and other professionals. Work aligning with personal values was important in sustaining motivation; for example, being part of a strong team and having outside professional interests appeared to build resilience.ConclusionGPs working in areas of high socioeconomic deprivation experience different types of work from those working in areas of low socioeconomic deprivation; much of which is unrecognised and not resourced. Current strategies to reduce burnout could be more effective if the complexity of different types of work was addressed. In addition, personal values, practice teams, and outside professional interests all need to be supported.
Highlights
IntroductionMultimorbidity (the presence of ≥2 long-term conditions) is a major challenge to global health systems,[1] and is associated with poorer outcomes and increased healthcare utilisation.[2]
Multimorbidity is a major challenge to global health systems,[1] and is associated with poorer outcomes and increased healthcare utilisation.[2]
GPs working in areas of high socioeconomic deprivation experience different types of work from those working in areas of low socioeconomic deprivation; much of which is unrecognised and not resourced
Summary
Multimorbidity (the presence of ≥2 long-term conditions) is a major challenge to global health systems,[1] and is associated with poorer outcomes and increased healthcare utilisation.[2]. In areas of high socioeconomic deprivation, GP consultation rates are higher, covering more problems in less time, with no additional resource.[5,6,7] In this context, psychosocial problems are more common, referrals more complex,[8] and patients often struggle to manage their illnesses.[9] Consultations demonstrate lower levels of patient enablement and higher levels of GP stress.[6,7]. There is a GP workforce crisis, in areas of high socioeconomic deprivation where levels of multimorbidity and social complexity are higher than in areas of low socioeconomic deprivation How this impacts GP work, and how GPs manage workload has not been fully explored
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