Abstract
BackgroundThe United Kingdom (UK) is experiencing a general practitioner (GP) workforce retention crisis. Research has focused on investigating why GPs intend to quit, but less is known about the acceptability and effectiveness of policies and strategies to improve GP retention. Using evidence from research and key stakeholder organisations, we generated a set of potential policies and strategies aimed at maximising GP retention and tested their appropriateness for implementation by systematically consulting with GPs.Methods28 GP Partners and GPs working in national stakeholder organisations from South West England and London were purposively sampled, and asked to take part in a RAND/UCLA Appropriateness Method panel. Panellists were asked to read an evidence briefing summary, and then complete an online survey on two occasions. During each round, participants rated the appropriateness of policies and strategies aimed at improving GP retention using a nine point scale (1 ‘extremely inappropriate’ to 9 ‘extremely appropriate’). Fifty-four potential policies and strategies (equating to 100 statements) were tested, focusing on factors influencing job satisfaction (e.g. well-being, workload, incentives and remuneration, flexible working, human resources systems). Ratings were analysed for panel consensus and categorised based on appropriateness (‘appropriate’, ‘uncertain’, ‘inappropriate’).Results12/28 GPs approached agreed to take part, 9/28 completed two rounds of the online survey between February and June 2018. Panellists identified 24/54 policy and strategy areas (41/100 statements) as ‘appropriate’. Examples included providing GP practices ‘at risk’ of experiencing GP shortages with a toolkit for managing recruitment and retention, and interventions to facilitate peer support to enhance health and wellbeing, or support portfolio careers. Strategies to limit GP workload, and manage patient demand were also endorsed.ConclusionsThe panel of experienced GPs identified a number of practical ways to improve GP retention through interventions that might enhance job satisfaction and work-life balance. Future research should evaluate the impact of implementing these recommendations.
Highlights
The United Kingdom (UK) is experiencing a general practitioner (GP) workforce retention crisis
The UK is experiencing a shortfall in the GP workforce, as evidenced by a substantial increase in the number of unfilled GP full-time posts [2], and a shift toward part-time working within the existing workforce [3]
The selected papers, reports and policy developments were summarised into a short evidence briefing paper for consideration by the panellists (Additional file 1). From these evidence sources, combined with the conceptual framework presented in the ReGROUP evidence review [7], we developed a list of inclusion and exclusion criteria (Table 1) to guide the selection and development of policies and strategies considered by panellists
Summary
The United Kingdom (UK) is experiencing a general practitioner (GP) workforce retention crisis. Using evidence from research and key stakeholder organisations, we generated a set of potential policies and strategies aimed at maximising GP retention and tested their appropriateness for implementation by systematically consulting with GPs. Demand for UK general practice-based primary care has consistently risen over the last 7 years, with the largest increase (13.6%) observed in consultation rates for general practitioners (GPs) [1]. Numerous workforce surveys have highlighted a retention crisis; a conservative estimate is that in the 5 years around a third of GPs intend to quit, reduce hours or seek alternatives to working in direct patient care [4, 5]. This review identified a number of ‘push’ and ‘pull’ factors which influenced decisions to reduce hours or leave direct patient care. The review findings were used to inform the design of potential recruitment and retention interventions aiming to improving job satisfaction and addressing issues relating to stress in the work place
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