Abstract
BackgroundThe general practice (GP) workforce in England is in crisis, reflected in increasing rates of early retirement and intentions to reduce hours of working. This study aimed to investigate underlying factors and how these might be mitigated.MethodsGPs in central England were invited to participate in an on-line survey exploring career plans and views and experiences of work-related pressures. Quantitative data were analysed using logistic regression analysis and principal components analysis. Qualitative data were analysed using a thematic framework approach.ResultsOf 1,192 GPs who participated, 978 (82.0 %) stated that they intend to leave general practice, take a career break and/or reduce clinical hours of work within the next five years. This included 488 (41.9 %) who intend to leave practice, and almost a quarter (279; 23.2 %) intending to take a career break. Only 67 (5.6 %) planned to increase their hours of clinical work.For participants planning to leave practice, the issues that most influenced intentions were volume and intensity of workload, time spent on “unimportant tasks”, introduction of seven-day working and lack of job satisfaction.Four hundred fifty five participants responded to open questions (39128 words in total). The main themes were the cumulative impact of work-related pressures, the changing and growing nature of the workload, and the consequent stress.Reducing workload intensity, workload volume, administrative activities, with increased time for patient care, no out-of-hour commitments, more flexible working conditions and greater clinical autonomy were identified as the most important requirements to address the workforce crisis. In addition, incentive payments, increased pay and protected time for education and training were also rated as important.ConclusionsNew models of professionalism and organisational arrangements may be needed to address the issues described here. Without urgent action, the GP workforce crisis in England seems set to worsen.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0363-1) contains supplementary material, which is available to authorized users.
Highlights
Introduction of7 day a week workingLonger appointment timesReduced job satisfactionNo out of hours commitmentsLack of time for patient contactMore flexible working conditionsPoor flexibility of hoursGreater clinical autonomy RevalidationImproved skill-mix in the practiceShorter practice opening times
The gender distribution was representative of the West Midlands general practice (GP) population (55.7 % male, 44.3 % female) [13], the age distribution was broadly representative, except for over-representation of participants aged between 50–59 years (38 % respondents compared to 28 % regionally) and those trained in UK/Ireland (85.8 % respondents; 72.6 % regionally), and under-representation of participants from practices with one or two GPs (8.4 % respondents; 36.5 % regionally)
For the logistic regression this was 86 % (1027/1192) of the full study population and for the principal components analyses (PCA) ranged between 76 % (371/ 488) and 80 % (391/488) of GPs who intend to leave general practice in the five years
Summary
Introduction of7 day a week workingLonger appointment timesReduced job satisfactionNo out of hours commitmentsLack of time for patient contactMore flexible working conditionsPoor flexibility of hoursGreater clinical autonomy RevalidationImproved skill-mix in the practiceShorter practice opening times. The general practice (GP) workforce in England is in crisis, reflected in increasing rates of early retirement and intentions to reduce hours of working. The General Practice (GP) workforce in the UK has been declared to be at “crisis point” [1]. There are difficulties in both recruiting doctors to GP specialist training [2] and an increasing trend to part-time working and earlier retirement [3, 4]. The relevance of such measures to the issues that are driving GPs to contemplate leaving clinical practice needs further investigation. The British Government’s commitment to 7-day access to GPs by 2020 [12] risks exacerbating the workforce issues
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