The workforce crisis in general practice

Marshall, Martin; Ikpoh, Margaret

doi:10.3399/bjgp22x719213

Cited by 10 publications

(5 citation statements)

References 1 publication

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“…General practice and primary care are undergoing a workforce crisis globally [ 1 , 2 ]. Growing demand, an ageing population, and more people living with complex or multiple long-term conditions, including dementia, have changed the landscape of primary care.…”

Section: Introductionmentioning

confidence: 99%

“…Growing demand, an ageing population, and more people living with complex or multiple long-term conditions, including dementia, have changed the landscape of primary care. Workforce challenges in general practice; specifically general practitioner (GP) recruitment and retention, are compounding problems [ 1 , 3 ]. To meet these challenges and provide high quality care, a diversity of professions in primary care is needed.…”

Section: Introductionmentioning

confidence: 99%

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Models of care and the role of clinical pharmacists in UK primary care for older adults: A scoping review protocol

Davies,

Kolodin,

Woodward

et al. 2023

PLoS ONE

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Introduction There has been global investment of new ways of working to support workforce pressures, including investment in clinical pharmacists working in primary care by the NHS in the England. Clinical pharmacists are well suited to support older adults who have multiple long-term conditions and are on multiple medications. It is important to establish an evidence base for the role of clinical pharmacists in supporting older adults in primary care, to inform strategic and research priorities. The aim of this scoping review is to identify, map and describe existing research and policy/guidance on the role of clinical pharmacists in primary care supporting older adults, and the models of care they provide. Methods and analysis A scoping review guided by the Joanne Briggs Institute methodology for scoping reviews, using a three-step strategy. We will search Medline, CINAHL, Scopus, EMBASE, Web of Science, PSYCHInfo, and Cochrane for English language articles, from 2015 –present day. Grey literature will be searched using Grey Matters guidelines, the Index of Grey Literature and Alternative Sources and Resources, and Google keyword searching. References of all included sources will be hand searched to identify further resources. Using the Population, Concept and Context framework for inclusion and exclusion criteria, articles will be independently screened by two reviewers. The inclusion and exclusion criteria will be refined after we become familiar with the search results, following the iterative nature of a scoping review. Data will be extracted using a data extraction tool using Microsoft Excel and presented using a narrative synthesis approach. Ethics and dissemination Ethical approval is not required for this review. Review findings will be disseminated in academic conferences and used to inform subsequent qualitative research. Findings will be published and shared with relevant local and national organisations.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Models of care and the role of clinical pharmacists in UK primary care for older adults: A scoping review protocol

Davies,

Kolodin,

Woodward

et al. 2023

PLoS ONE

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“…The pressures of the current workforce and workload crisis in general practice 24 may affect practices’ ability to provide the time and resources to support locums. Failing to provide support with appraisal and feedback for locums could result in locums feeling marginalised and excluded, 12 which in turn does not contribute towards goals of improved patient safety and collaboration.…”

Section: Discussionmentioning

confidence: 99%

Locum doctors in English general practices: evidence from a national survey

Stringer

Ferguson²,

Walshe³

et al. 2023

Br J Gen Pract

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Background: Locum doctors give practices flexibility to deliver patient services but there are concerns about the impact of locum working on continuity of care, patient safety, team function and cost. Aim: To explore locum working in English general practices and understand why and where locum doctors were needed and how they were engaged, supported, perceived and managed. Design and Setting: An online survey was sent to 3745 practices. Methods: Quantitative responses analysed using frequency tables, t-tests and correlations. Free-text responses were analysed using thematic analysis. Results: 605 responses were returned (16.2%). Practices made frequent use of locums, preferring regular locums familiar with processes and patients. Disadvantages of agency locums included cost, lack of patient familiarity and impact on continuity of care. Care provided by locums was generally viewed as the same but sometimes worse compared to permanent GPs. Some practices reported that locums did not always perform the full range of duties resulting in increased workload for other staff. Practices were largely unfamiliar with national guidance for organisations engaging locums and while processes like verifying documentation were conducted, far fewer respondents reported providing feedback, support for revalidation, or professional development. Conclusion: Locum working is an essential part of English general practice, but our research raises some concerns about the robustness of arrangements for locum working and impact on quality and safety of care. Further research is needed on the clinical practice and performance of locums, and to explore how locum working can be organised in ways that assure safe and high quality care.

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“…Changes in doctors' working patterns have been attributed to unmanageable workloads and burnout, reported by doctors in all areas of the profession [ 12 ]. A decline in full‐time working in favour of part‐time, portfolio and locum working [ 13 ] combined with persistent understaffing [ 14 ] and unprecedented demand for appointments [ 15 ] has resulted in detrimental effects for patient access to healthcare and continuity of the doctor−patient relationships [ 16 ]. Public satisfaction with access to care is at an all‐time low [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

‘None of Them Know Me’: A Qualitative Study of the Implications of Locum Doctor Working for Patient Experience

Ferguson,

Stringer,

Walshe

et al. 2024

Health Expectations

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IntroductionThere have been some concerns about the impact of temporary doctors, otherwise known as locums, on patient safety and the quality of care. Despite these concerns, research has paid little attention to the implications of locum working on patient experience.MethodsA qualitative semi‐structured interview study was conducted with 130 participants including locums, people working with locums and patients with experience of being seen or treated by locums. Analysis was conducted using a reflexive thematic approach and abductive analysis to position themes against wider knowledge.ResultsThree main themes were constructed through analysis: (1) Awareness and disclosure; patients were not always aware if their doctor was a locum, and there was some debate about whether patients had a right to know, particularly if locum working presented quality and safety risks. (2) Continuity and accessibility of care; access was regarded as priority for acute conditions, but for long‐term or serious conditions, patients preferred to see a permanent doctor who knew their history, although it was acknowledged that locums could provide fresh perspectives. (3) Communication and practice; locums and patients described how consultations were approached differently when doctors worked as locums. Patients evaluated their interactions based on how safe they felt with practitioners.ConclusionPatients reported that they were unlikely to have continuity of care with any doctors delivering care, regardless of their contractual status. Locums sometimes provided new perspectives on care which could be beneficial for patient outcomes, but for patients with long‐term, complex or serious conditions continuity of care was important, and these patients may avoid or delay seeking care when locums are the only available option.Patient or Public ContributionPatients and carers were involved in our study from inception to dissemination. Our Patient and Public Involvement (PPI) forum was involved throughout project design and planning and gave us feedback and guidance on research materials and outputs (e.g., study protocol, participant information sheets, survey tools, interview schedules, emerging findings). Our PPI forum co‐produced our patient interview schedule, two members of our PPI forum led the patient focus groups and all were involved in analysis of patient interviews. Our PPI Chair was involved in the preparation of this manuscript.

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The workforce crisis in general practice

Cited by 10 publications

References 1 publication

Models of care and the role of clinical pharmacists in UK primary care for older adults: A scoping review protocol

Models of care and the role of clinical pharmacists in UK primary care for older adults: A scoping review protocol

Locum doctors in English general practices: evidence from a national survey

‘None of Them Know Me’: A Qualitative Study of the Implications of Locum Doctor Working for Patient Experience

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