GP views on strategies to cope with increasing workload: a qualitative interview study

Abstract

BackgroundThe existence of a crisis in primary care in the UK is in little doubt. GP morale and job satisfaction are low, and workload is increasing. In this challenging context, finding ways for GPs to manage that workload is imperative.AimTo explore what existing or potential strategies are described by GPs for dealing with their workload, and their views on the relative merits of each.Design and settingSemi-structured, qualitative interviews with GPs working within NHS England.MethodAll GPs working within NHS England were eligible. Of those who responded to advertisements, a maximum-variation sample was selected and interviewed until data saturation was reached. Data were analysed thematically.ResultsResponses were received from 171 GPs, and, from these, 34 were included in the study. Four main themes emerged for workload management: patient-level, GP-level, practice-level, and systems-level strategies. A need for patients to take greater responsibility for self-management was clear, but many felt that GPs should not be responsible for this education. Increased delegation of tasks was felt to be key to managing workload, with innovative use of allied healthcare professionals and extended roles for non-clinical staff suggested. Telephone triage was a commonly used tool for managing workload, although not all participants found this helpful.ConclusionThis in-depth qualitative study demonstrates an encouraging resilience among GPs. They are proactively trying to manage workload, often using innovative local strategies. GPs do not feel that they can do this alone, however, and called repeatedly for increased recruitment and more investment in primary care.

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

“…Data on GP strategies for dealing with workload are published in a separate, accompanying article. 17 Participants' descriptions of workload Most participants described long, intense days spent in general practice. Typical working days ranged from 10-14 hours, often with little or no time for breaks.…”

“…Difficulty recruiting doctors, lack of a solution provided by locums, and the financial pressures on practices further indicate that coping strategies are presently limited (the authors' accompanying article on GPs' suggestions for strategies to cope with increasing workload is published alongside this article). 17 The unattractiveness of partnership is particularly worrying because these positions are mainly occupied by the most experienced GPs who are in the best position to be able to retire.…”

Barriers, facilitators, and survival strategies for GPs seeking treatment for distress: a qualitative study

“…Existing qualitative work has tended to use smaller samples. 6,21,22 or examine the experiences of GPs in different parts of the world. 17 The study aimed to address these limitations by eliciting a larger group of English GPs' feelings concerning what helps and hinders them in receiving support for their chronic stress or distress, hence giving greater weight to the intrinsic, rather than extrinsic, value of GP wellbeing.…”

“…24,39 A recent article found that many GPs have reduced their sessions in order to cope with the stress of an increasing workload. 22 These findings build on this by adding detail to the ways in which GPs might vary their working days or assert their boundaries, demonstrating ways in which individual GPs may protect themselves within the current general practice structure. However, while these may be beneficial strategies for the individual, they could have damaging consequences for patients and the profession unless there are resources available to recruit more GPs.…”

“…Finally, the authors recommend that researchers and policymakers respond to research such as theirs and others, 6,7 as well as the General Practice Forward View, 40 by investigating and developing organisational changes that will enable the workload stresses experienced by GPs to become more manageable for individuals, 22,41,42 while ensuring sufficient resource and practitioners for the delivery of good medical care for all. These strategies must emphasise both the mental and physical health of GPs by putting in place measures both to prevent distress and provide support should it arise, so that the profession may continue to thrive and grow.…”