Objective To identify factors influencing general practitioners' (GPs’) decisions about whether or not to remain in direct patient care in general practice and what might help to retain them in that role.
Design Qualitative, in-depth, individual interviews exploring factors related to GPs leaving, remaining in and returning to direct patient care.
Setting South West England, UK.
Participants 41 GPs: 7 retired; 8 intending to take early retirement; 11 who were on or intending to take a career break; 9 aged under 50 years who had left or were intending to leave direct patient care and 6 who were not intending to leave or to take a career break. Plus 19 stakeholders from a range of primary care-related professional organisations and roles.
Results Reasons for leaving direct patient care were complex and based on a range of job-related and individual factors. Three key themes underpinned the interviewed GPs’ thinking and rationale: issues relating to their personal and professional identity and the perceived value of general practice-based care within the healthcare system; concerns regarding fear and risk, for example, in respect of medical litigation and managing administrative challenges within the context of increasingly complex care pathways and environments; and issues around choice and volition in respect of personal social, financial, domestic and professional considerations. These themes provide increased understanding of the lived experiences of working in today’s National Health Service for this group of GPs.
Conclusion Future policies and strategies aimed at retaining GPs in direct patient care should clarify the role and expectations of general practice and align with GPs’ perception of their own roles and identity; demonstrate to GPs that they are valued and listened to in planning delivery of the UK healthcare; target GPs’ concerns regarding fear and risk, seeking to reduce these to manageable levels and give GPs viable options to support them to remain in direct patient care.
- qualitative research
- primary care
- health services administration & management
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Contributors AS and RT contributed to the study design, data collection, analysis and writing of the paper. JLC and SGD contributed to study design, analysis and writing of the paper. SR, CS, AA, LS, EF, LL and JW contributed to the study design and writing of the paper. All authors read and approved the final paper. JLC is the guarantor of the paper.
Funding The project was funded by the National Institute for Health Research, Health Service and Delivery Research programme (project 14/196/02). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Health Service and Delivery Research programme, the National Institute for Health Research, the National Health Service or the Department of Health. JW is generously supported by a Wellcome Trust Institutional Strategic Support Award (WT105618MA). SD’s position is partially supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust.
Competing interests All authors have completed the ICMJE uniform disclosure at www.icmje.org/coi_disclosure.pdf and declare: financial support for the submitted work was received from the National Institute for Health Research (HS&DR); JW is supported by a Wellcome Trust Institutional Strategic Support Award; AA has received personal fees from Northern Eastern Western Devon CCG, Devon Local Medical Committee, British Medical Association, University of Exeter, SouthWest CLAHRC and NHS England Medical Directorate (South), outside of this work.
Ethics approval University of Exeter Medical School Research Ethics Committee (UEMS REC reference 15/11/085, 3 December 2015).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
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