Anna Sansom

Understanding quit decisions in primary care: a qualitative study of older GPs

Objective To investigate the reasons behind intentions to quit direct patient care among experienced general practitioners (GPs) aged 50–60 years. Design and setting Qualitative study based on semistructured interviews with GPs in the South West region of England. Transcribed interviews were analysed thematically. Participants 23 GPs aged 50–60 years: 3 who had retired from direct patient care before age 60, and 20 who intended to quit direct patient care within the next 5 years. Results The analysis identified four key themes: early retirement is a viable option for many GPs; GPs have employment options other than undertaking direct patient care; GPs report feeling they are doing an (almost) undoable job; and GPs may have other aspirations that pull them away from practice. Findings from this study confirmed those from earlier research, with high workload, ageing and health, family and domestic life, and organisational change all influencing GPs’ decisions about when to retire/quit direct patient care. However, in addition, GPs expressed feelings of insecurity and uncertainty regarding the future of general practice, low morale, and issues regarding accountability (appraisal and revalidation) and governance. Suggestions about how to help retain GPs within the active clinical workforce were offered, covering individual, practice and organisational levels. Conclusions This research highlights aspects of the current professional climate for GPs that are having an impact on retirement decisions. Any future changes to policy or practice to help retain experienced GPs will benefit from this informed understanding of GPs’ views. Key factors to take into account include: making the GP workload more manageable; managing change sympathetically; paying attention to GPs’ own health; improving confidence in the future of general practice; and improving GP morale.

Pharmacists’ perceptions of their emerging general practice roles in UK primary care: a qualitative interview study

Background UK general practice is experiencing a workload crisis. Pharmacists are the third largest healthcare profession in the UK; however, their skills are a currently underutilised and potentially highly valuable resource for primary health care. This study forms part of the evaluation of an innovative training programme for pharmacists who are interested in extended roles in primary care, advocated by a UK collaborative ‘10-point GP workforce action plan’. Aim To explore pharmacists’ perceptions of primary care roles including the potential for greater integration of their profession into general practice. Design and setting A qualitative interview study in UK primary care carried out between October 2015 and July 2016. Method Pharmacists were purposively sampled by level of experience, geographical location, and type of workplace. Two confidential semi-structured telephone interviews were conducted — one before and one after the training programme. A constant comparative, inductive approach to thematic analysis was used. Results Sixteen participants were interviewed. The themes related to: initial expectations of the general practice role, varying by participants’ experience of primary care; the influence of the training course with respect to managing uncertainty, critical appraisal skills, and confidence for the role; and predictions for the future of this role. Conclusion There is enthusiasm and willingness among pharmacists for new, extended roles in primary care, which could effectively relieve GP workload pressures. A definition of the role, with examples of the knowledge, skills, and attributes required, should be made available to pharmacists, primary care teams, and the public. Training should include clinical skills teaching, set in context through exposure to general practice, and delivered motivationally by primary care practitioners.

Quitting patient care and career break intentions among general practitioners in South West England: findings of a census survey of general practitioners

Objective Given recent concerns regarding general practitioner (GP) workforce capacity, we aimed to describe GPs’ career intentions, especially those which might impact on GP workforce availability over the next 5 years. Design Census survey, conducted between April and June 2016 using postal and online responses , of all GPs on the National Health Service performers list and eligible to practise in primary care. Two reminders were used as necessary. Setting South West England (population 3.5  million), a region with low overall socioeconomic deprivation. Participants Eligible GPs were 2248 out of 3370 (67 % response rate). Main outcome measures Reported likelihood of permanently leaving or reducing hours spent in direct patient care or of taking a career break within the next 5 years and present morale weighted for non-response. Results Responders included 217 7 GPs engaged in patient care. Of these, 863 (37% weighted, 95%  CI 35 % to 39 %) reported a high likelihood of quitting direct patient care within the next 5 years. Overall, 1535 (70% weighted, 95%  CI 68 % to 72 %) respondents reported a career intention that would negatively impact GP workforce capacity over the next 5 years, through permanently leaving or reducing hours spent in direct patient care, or through taking a career break. GP age was an important predictor of career intentions; sharp increases in the proportion of GPs intending to quit patient care were evident from 52 years. Only 305 (14% weighted, 95%  CI 13 % to 16 %) reported high morale, while 1195 ( 54 % weighted, 95%  CI 52 % to 56 %) reported low morale. Low morale was particularly common among GP partners. Current morale strongly predicted GPs’ career intentions; those with very low morale were particularly likely to report intentions to quit patient care or to take a career break. Conclusions A substantial majority of GPs in South West England report low morale. Many are considering career intentions which, if implemented, would adversely impact GP workforce capacity within a short time period. Study registration NIHR HS&DR - 14/196/02, UKCRN ID 20700.

P72 Understanding why uk gps are leaving general practice–a systematic review of qualitative research

Background UK GPs are quitting direct patient care. The research presented here is part of a wider mixed methods study (ReGROUP) which focuses on retention of the experienced GP workforce, and on supporting the return to work of GPs following a career break. We undertook a qualitative synthesis of the evidence to identify factors that affect GPs’ retention in the workforce and that affect GPs’ decisions to quit direct patient care, take career breaks from general practice, and return to general practice after a career break Methods Five UK interview-based studies were identified and quality assessed using the adapted “Wallace tool”. A thematic synthesis was performed using NVivo software and a detailed explanatory model was constructed to provide an overview of the key contexts and factors affecting UK GPs in practice. Applicability of the explanatory model was verified by patient representatives in a patient and public involvement (PPI) workshop as well as by stakeholders from the wider research team. Results Three central dynamics key to understanding UK GP quitting behaviour emerged – factors associated with low job satisfaction, high job satisfaction, and those linked to the doctor-patient relationship. The importance of contextual influence, especially the changing nature of clinical practice, was noted. GPs with high job satisfaction describe feeling supported by good practice relationships, while GPs with poor job satisfaction report feeling overworked and unsupported. Combined with changing relationships with patients and interfaces with secondary care, and the gradual sense of loss of control over large parts of the job, many GPs report a reduction in job satisfaction. Once job satisfaction has become negatively impacted, the combined pressures of increased patient demand and workload together with other stress factors has left many feeling unsupported and vulnerable to burnout and ill health, and, ultimately, to the decision to leave general practice. Conclusion Job satisfaction appears to be a key indicator of whether a GP will successfully adapt and remain in practice, or will become overwhelmed by external influences and pressures and leave the profession. Many GPs report that job satisfaction directly relates to the quality of the doctor-patient relationship, and is dependent on the time available for GPs to spend with their patients.

Feasibility, acceptability and effectiveness of an online alternative to face-to-face consultation in general practice: a mixed-methods study of webGP in six Devon practices.

Objectives To evaluate the feasibility, acceptability and effectiveness of webGP as piloted by six general practices. Methods Mixed-methods evaluation, including data extraction from practice databases, general practitioner (GP) completion of case reports, patient questionnaires and staff interviews. Setting General practices in NHS Northern, Eastern and Western Devon Clinical Commissioning Group’s area approximately 6 months after implementing webGP (February–July 2016). Participants Six practices provided consultations data; 20 GPs completed case reports (regarding 61 e-consults); 81 patients completed questionnaires; 5 GPs and 5 administrators were interviewed. Outcome measures Attitudes and experiences of practice staff and patients regarding webGP. Results WebGP uptake during the evaluation was small, showing no discernible impact on practice workload. The completeness of cross-sectional data on consultation workload varied between practices. GPs judged 41/61 (72%) of webGP requests to require a face-to-face or telephone consultation. Introducing webGP appeared to be associated with shifts in responsibility and workload between practice staff and between practices and patients. 81/231 patients completed a postal survey (35.1% response rate). E-Consulters were somewhat younger and more likely to be employed than face-to-face respondents. WebGP appeared broadly acceptable to patients regarding timeliness and quality/experience of care provided. Similar problems were presented by all respondents. Both groups appeared equally familiar with other practice online services; e-consulters were somewhat more likely to have used them. From semistructured staff interviews, it appeared that, while largely acceptable within practice, introducing e-consults had potential for adverse interactions with pre-existing practice systems. Conclusions There is potential to assess the impact of new systems on consultation patterns by extracting routine data from practice databases. Staff and patients noticed subtle changes to responsibilities associated with online options. Greater uptake requires good communication between practice and patients, and organisation of systems to avoid conflicts and misuse. Further research is required to evaluate the full potential of webGP in managing practice workload.