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Study shows why GPs quit patient care

GP workforce in 'precarious state'

Jo Carlowe

Monday, 05 February 2018

New research has shed light on why doctors are leaving General Practice.

The study: ‘Why do GPs leave direct patient care and what might help to retain them? A qualitative study of GPs in South West England’*, published in BMJ Open, aimed to identify factors influencing GPs’ decisions about whether or not to remain in direct patient care, and what might help to retain them in the role.

Led by professor John Campbell of the University of Exeter Medical School, and funded by the National Institute for Health Research (NIHR), the researchers interviewed 41 GPs for the study, and identified three main themes underpinning the GPs’ thinking and rationale.

Three reasons emerged: a sense that general practice based primary care was under-valued within the healthcare system; concerns regarding professional risk encountered in delivering care in an increasingly complex health environment; and finally, considerations about leaving or remaining in direct patient care and the options and choices that GPs felt were available to them.

It follows a large-scale survey led by professor Campbell, which showed that two in every five GPs in the South West intended to quit within the next five years.

Professor Campbell, who is a practising GP, said: “Our new research is a significant study of what is driving the exodus of GPs from direct patient care. Policy makers need to take this onboard and address these issues to retain GPs and encourage medical students to take up a career in general practice. Despite recent government plans to address the problem, numbers are continuing to fall. If we do not act now, many areas will face a severe shortfall in the number of GPs providing care for patients in their area.”

The research adds to the picture of a crisis developing around the national GP workforce in the last five years. The number of unfilled GP posts quadrupled between 2012 and 2014, while the numbers of GPs fell substantially. The national situation has prompted political action, with the Government announcing measures to train 5,000 new GPs in 2015, and to increase the proportion of medical students who choose general practice as a career. Despite this, government data showed that over 1000 GPs left full-time practice between 2016 and 2017.

Professor Campbell said: “We now need sustained, strategic, and stable planning of health services – not a series of short-term ‘fixes’ which only destabilise clinical care further. Innovation is essential, but needs to be based on firm evidence.”

Responding to the findings, professor Helen Stokes-Lampard, chair of the Royal College of GPs, said: "This research provides important understanding into why GPs are leaving the profession – and hammers home why the College's calls for thousands more GPs must be heard and acted upon.

"GP workload has increased by at least 16% over the last seven years – and become far more complex - but the share of the overall NHS budget that general practice receives is less that it was a decade ago, and our workforce has not risen at pace. The relentless pressure has simply become too much for many GPs. Our workforce is in a precarious state – and currently well-intentioned plans to increase GP numbers in the NHS are at risk of falling short of target.”

She added: “We need the pledge of 5,000 more GPs by 2020 made in NHS England’s GP Forward View to be delivered, in full, and as a matter of urgency – but the latest workforce figures actually showed a concerning drop of more than 600 full-time equivalent family doctors between March-September last year.

"Ultimately, it’s our patients who suffer when we lose GPs, and this study not only highlights the need to recruit more doctors into general practice for the future, but to also take measures to retain existing and experienced doctors working in NHS general practice.”

An NHS England spokesperson said: “NHS England is putting hundreds of millions of pounds of extra investment into GP services with plans for 5,000 more GPs and a further 5,000 extra practice staff which will provide additional support for practices and to reduce workload. We have record numbers of GP trainees, with programmes in place to bring more doctors from overseas and to support existing GPs with more flexible working.”

*Sansom A, Terry R, Fletcher E, et al. Why do GPs leave direct patient care and what might help to retain them? A qualitative study of GPs in South West England. BMJ Open 2018;8:e019849. doi: 10.1136/bmjopen-2017-019849

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