Retaining the general practitioner workforce: what matters to GPs? Jeremy Dale1, Rachel Potter2, Katherine Owen3, Nicholas Parsons4, Alba Realpe5, Jonathan Leach6

Why are GPs planning to leave?

• Whilst various initiatives have been suggested to aid GP retention our survey suggests that without addressing workload and morale issues these are unlikely to be successful.

• Government initiatives to expand GP access to 7 day a week working are likely to exacerbate the problem.

Conclusions

82.5% of GPs intend to leave General Practice, take a career break or reduce their clinical hours of work in the next 5

years 41.9% of GPs intend to leave General Practice completely

Introduction

The importance of each factor rated by GPs from 1 (not important) to 5 (very important)

Mean score (SD)

Volume of workload 4.5 (0.92)

Intensity of workload 4.6 (0.86)

Time spent on unimportant tasks 4.4 (0.97)

Introduction of 7 day week 4.2 (1.2)

Reduced job satisfaction 4.2 (1.1)

Additional reasons identified from free text comments

• Growth in patient expectations and demand• Recruitment and retention difficulties• Transfer or work from secondary care• Increasing complexity and chronic ill health• Cumulative impact of work-related pressure• Negative portrayal of GPs by government and media

“The administrative workload has increased to unmanageable levels over the past 3-4 years. Transfer of unfunded work from secondary care is escalating... All of the full time partners are desperate to reduce their commitment…”

“Morale is extremely low as GPs are battered by the media and blamed for the increased demands on OOH care, despite the fact that I feel we are working harder than ever.”

“The pressure is tremendous. I get home after a 10 hour day and feel as if I have been hit round the head with a brick…I am only 40 yet feel burnt out.”

“A more realistic approach from the government about what is possible. Instead of constantly beating GP's alongside poor investment in primary care, looking at what we do and how well

we do it should be championed”

Who responded?

1,192 GPs (32% of all W Midlands GPs) responded to the survey. The group was demographically representative in terms of gender, with some over-representation of the 50-59 age group and UK/Ireland educated GPs. GPs from smaller practices were under-represented. 455 participants provided additional free-text comments.

Age

25-2930-3940-4950-5960-6970+

Sex

MaleFemale

Role

PrincipalsNon-principals

• General Practice is facing a workforce crisis with difficulties recruiting to training places and an increasing trend to early retirement and part time working.

• A recent BMA survey highlighted workload as the main driver away from commitment to a career in General Practice.

• We undertook an on-line questionnaire of GPs working in the West Midlands to investigate what factors are influencing GPs to consider leaving general practice, plus which factors could encourage them to stay .

What might encourage them to stay?

“We need to be responsible for half the number of patients per doctor, i.e. we need double the number of GPs, now that we manage increasingly complex medical problems, carrying out much more intensive chronic disease management, in an increasingly frail and elderly population”

“Less meaningless bureaucracy is the main factor that would improve my working life.”

What would encourage GPs to stay?

The importance of each factor rated by GPs from 1 (not important) to 5 (very important)

Mean score

(SD)

Reduced intensity of workload 4.5 (0.91)

Reduced volume of workload 4.4 (0.92)

Less administrative activities 4.3 (1.0)

More time with patients 4.2 (1.1)

No out of hours 3.9 (1.5)

Incentive payments 3.7 (1.4)

Protected time for education and training

3.6 (1.3)

More flexible working conditions 3.5 (1.4)

Greater clinical autonomy 3.3 (1.4)

“A more realistic approach from the government about what is possible. Instead of constantly beating GP's alongside poor investment in primary care, looking at what we do and how well we do it should be championed.”

This project was funded by Health Education West Midlands and the Midland Faculty of the Royal College of General Practitioners

Contact: Jeremy.dale@warwick.ac.uk

1-5 Warwick Medical School, 6 Chair Midland Faculty RCGP