General practitioners' perceptions of sharing workload in group practices: qualitative study

Branson, Ruben; Armstrong, David

doi:10.1136/bmj.38173.532465.7c

Cited by 14 publications

(14 citation statements)

References 7 publications

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“…9,12,13,18,19 A recently published quantitative study using the Clinical Practice Research Datalink (CPRD) found a 12% rise in GP consultation rates between 2007-2008 and 2013-2014, and an increase in the duration of consultations, contributing to an overall workload increase of 16%. 20 A British Medical Association focus group identified similar issues to those highlighted here, including a shift in care provision from secondary to primary care, increasing patient expectations and demands (with some GPs practising defensively), too much bureaucracy, and partnership being unattractive due to high workload and responsibility.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

GPs’ perceptions of workload in England: a qualitative interview study

2017

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BackgroundGPs report the lowest levels of morale among doctors, job satisfaction is low, and the GP workforce is diminishing. Workload is frequently cited as negatively impacting on commitment to a career in general practice, and many GPs report that their workload is unmanageable.AimTo gather an in-depth understanding of GPs’ perceptions and attitudes towards workload.Design and settingAll GPs working within NHS England were eligible. Advertisements were circulated via regional GP e-mail lists and national social media networks in June 2015. Of those GPs who responded, a maximum-variation sample was selected until data saturation was reached.MethodSemi-structured, qualitative interviews were conducted. Data were analysed thematically.ResultsIn total, 171 GPs responded, and 34 were included in this study. GPs described an increase in workload over recent years, with current working days being long and intense, raising concerns over the wellbeing of GPs and patients. Full-time partnership was generally not considered to be possible, and many participants felt workload was unsustainable, particularly given the diminishing workforce. Four major themes emerged to explain increased workload: increased patient needs and expectations; a changing relationship between primary and secondary care; bureaucracy and resources; and the balance of workload within a practice. Continuity of care was perceived as being eroded by changes in contracts and working patterns to deal with workload.ConclusionThis study highlights the urgent need to address perceived lack of investment and clinical capacity in general practice, and suggests that managing patient expectations around what primary care can deliver, and reducing bureaucracy, have become key issues, at least until capacity issues are resolved.

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Section: Comparison With Existing Literaturementioning

confidence: 99%

GPs’ perceptions of workload in England: a qualitative interview study

2017

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“…The pattern for provision of primary care has changed radically since the early 1980s 1. The number of small, particularly single-handed, practices has declined rapidly, and most patients now receive a complex, often bewildering, range of primary care services from a large multiprofessional group, rather than seeing their usual general practitioner.…”

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confidence: 99%

Is trust an under-researched component of healthcare organisation?

Green

2004

BMJ

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The pattern for provision of primary care has changed radically since the early 1980s. 1 The number of small, particularly single-handed, practices has declined rapidly, and most patients now receive a complex, often bewildering, range of primary care services from a large multiprofessional group, rather than seeing their usual general practitioner. This shift has far reaching implications for how professionals work together to provide care and on how that care is experienced by patients. Assumptions that by simply increasing practice size patient care would somehow be improved have been undermined by empirical research on the relations between measures of practice organisation and quality of care. There is no simple relation: larger practices apparently perform better than smaller ones on some indicators of clinical quality of care but worse on factors such as access and continuity.2 3 Explaining how organisational factors relate to healthcare outcomes has become a prized, if unattainable, goal for health services research, and in primary care various mediators have been studied to try to understand the effect of practice organisation on quality of care, including list size, booking intervals for routine consultations, and measures of "team climate," a concept relating to how far a team share a vision of organisational goals and procedures. 2-4Nevertheless, limits exist to how far survey evidence can shed light on these relations when so little is known about how primary care organisations really work. Detailed qualitative research on workplace settings suggests that the organisational factors that investigators rush to measure are, in practice, complex processes. One example is consultant presence on intensive care units, posited as a predictor of good clinical outcomes. Recent ethnographic research found that it was not consultant presence in itself that was related to factors likely to improve patient care, but rather the nature of relationships a consultant engendered between nursing and clinical staff.5 There is a relative paucity of similar evidence on how professionals work together in the new primary care of large practices, with increasingly bureaucratic organisational structures. Branson and Armstrong's study is, then, an important contribution.Trust is likely to be a key mediator of relationships both between colleagues and between practitioners and their patients, and understanding how it is experienced, discussed, and built into practice systems will be crucial for understanding the contemporary organisation of primary care. Trust in modern society can be defined in two ways. Firstly, the embodied trust in known others, arising from enduring relationships that are embedded in wider social networks. In general practice, this is perhaps typified by the single-handed general practitioner, whose practice has long been part of a local community. Secondly, trust in impersonal regulatory systems, when contrasting demands are made. Here, the systems trusted most are those least contaminated by vested inte...

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“…The resentment about perceived inequalities in workload places a further burden on general practices. The issue of working together warrants further support (49). Furthermore, it is already documented that physicians practice in private services have a need for support so in Australia, peer support groups were founded.…”

Section: Study Fro M Bosnia and Herzegovina Indicates That Almost Halmentioning

confidence: 99%

Life Habits and Personal Behaviour of Physicians Working in Government Service and Private Practice in Croatia- a Pilot Study

Gruber¹

2012

PHR

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The goal of this research was to compare the life habits and personal health behaviour of 182 physicians in government services and in private services and to gain better insight in life habits and personal health behaviour of physicians in general. Methods: Using the 20 statements regarding life habits and personal health behaviour. Results: There are no differences between life habits of physicians regarding the type of service they work except that almost all physicians working in government services stated that they had at least a one close confidential friend wh ile only 2/3 of physicians practice in private services did so. Although 2/3 of doctors fro m both groups consider themselves "in good health", mo re than half of them stated that they were an inappropriate weight for their height and most of them did not exercise regularly. More than 1/3 always drinks more than five alcoholic drin ks a week and 1/3 always smoke more than half a pack of cigarettes a day. Conclusion: The type of service that physicians work in makes no difference on their life habits and personal behaviour except that physicians in private services have significantly less confidential friends. The better insight in life habits and personal behaviour of Croatian physicians was gained fro m the study and "target" spots for interventions are found: attitudes and behaviour considering unhealthy nutritional regimen, excessive alcohol consumption, smoking and lack of physical activity. The benefit of this study is that it emphasizes the need for further research on the subject, since there is a need for improvement of physician's attitudes, life habits and behaviour. Changing attitudes towards unhealthy nutritional regimen, excessive alcohol consumption, smoking and lack of physical activity could also be, for physicians, a beneficent way to improve the health of their patients serving as a "good model".

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General practitioners' perceptions of sharing workload in group practices: qualitative study

Cited by 14 publications

References 7 publications

GPs’ perceptions of workload in England: a qualitative interview study

GPs’ perceptions of workload in England: a qualitative interview study

Is trust an under-researched component of healthcare organisation?

Life Habits and Personal Behaviour of Physicians Working in Government Service and Private Practice in Croatia- a Pilot Study

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