GP workload: time for a rethink of the generalist model of care to promote retention

Lyon-Maris, Johnny; Edwards, Laura A.; Scallan, Samantha; Locke, Rachel

doi:10.3399/bjgp15x687145

Cited by 7 publications

(7 citation statements)

References 5 publications

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“…Particularly, there has been decreasing investment in primary care compared with hospitals, despite increasing expectations of the work that should be done in primary care, 8 and in combination with reducing numbers of GPs and increasing role complexity, GPs are struggling with workload. 24 Some strategies have been introduced at a practice level to try to address increased workload, such as telephone triage. 25 However, recent evidence suggests this is not effective.…”

Section: Implications For Practicementioning

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: Implications For Practicementioning

confidence: 99%

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

2017

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“…7 Causes of increased workload include increased administrative load, target management, high patient expectation, and increased risk of litigation. 9 Most GPs (90%) believe that high levels of workload damage the quality of patient care, and that 10-minute consultations are inadequate to meet patient needs, 8 although these concerns are not new. 10,11 Given the very real concerns about sustainability of UK general practice, change and resilience seem necessary for survival.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…For instance, as raised by Lyon-Maris et al's informants, portfolio roles have the potential to make being a GP very attractive. 1 There are countless examples of GPs pursuing such portfolio careers. 2,3 Unfortunately, not many colleagues know what a portfolio GP is.…”

Section: Give Us a Reason To Be A Gpmentioning

confidence: 99%

“…Thank you for providing guidance for adults with suspected inflammatory bowel disease (IBD). 1 Unfortunately paediatric gastroenterologists receive more referrals to endoscope children on the basis of a 'positive' faecal calprotectin test based on the false interpretation of a cut-off of 50 µg/g faeces as a surrogate for IBD in children. However, the meta-analysis clearly illustrates an important age-dependent difference of applying the test in children (0-16 years).…”

Section: The Diagnostic Accuracy Of Faecal Calprotectin In Investigatmentioning

confidence: 99%