Retention crisis in general practice must be tackled, says think tank

A new international analysis of attitudes of primary care doctors has identified “a clear correlation” between stress levels among GPs in the United Kingdom and their desire to leave their job.

The UK health policy charity the Health Foundation analysed findings from a survey by the US think tank the Commonwealth Fund that compared attitudes among 11 500 primary care doctors from 11 industrialised nations, including 1001 GPs in the UK.

Some 29% of the UK GPs surveyed said that they planned to leave general practice within five years, with 82% of those planning to leave medicine for a different career saying that their current role was extremely or very stressful. In contrast, only 48% of UK GPs who planned to remain in the profession identified their role as extremely or very stressful.

The results mirror a survey by the BMA last year that found that a third of UK GPs were considering retiring from general practice in the next five years, with some citing “significant and unmanageable” stress as a driving factor behind their decision.1

The Health Foundation’s analysis, released to The BMJ ahead of the publication of its full report on the Commonwealth Fund’s results, found that reported levels of stress and dissatisfaction were higher in the UK than in the other countries surveyed. Two thirds (67%) of UK GPs reported being satisfied with practising medicine, whereas the average across the other 10 countries surveyed was 79%.

The foundation said that retaining existing GPs by improving their working lives should be as great a priority for the government and the NHS as recruiting new GPs, given the government’s stated aim to develop more healthcare services outside hospitals.

The survey identified the UK as an outlier on length of appointment times, with 92% of UK GPs reporting spending less than 15 minutes with patients, compared with 27% for the international average. Only 26% of UK GPs said that they were satisfied with the amount of time they spent with patients, compared with an average of 59% satisfied in the other countries.

UK GPs’ satisfaction with their income was broadly similar to that among their colleagues in other countries, with 67% of UK GPs satisfied with their income and 72% internationally. But UK GPs were far more satisfied than international colleagues when asked to compare their incomes with those of specialists, with 58% of UK GPs satisfied but just 38% in other countries.

The Health Foundation, which part funded the Commonwealth Fund’s survey and helped formulate the questions, will be publishing its wider analysis in the next few weeks.

Jennifer Dixon, chief executive of the Health Foundation, said, “These worrying findings reveal the scale of the challenge facing general practice. There is already a shortage of GPs in the NHS, and with 29% reporting they are planning to leave within five years we must urgently understand the reasons for UK GPs’ dissatisfaction.

“The survey suggests UK GPs’ unhappiness is not related to their income but may be driven by their spending less time with patients than they would like and experiencing higher levels of stress than GPs internationally. The relentless appointment treadmill experienced by UK GPs is in stark contrast to that reported by their peers overseas.”

Dixon added, “Focusing on recruiting new GPs alone will not solve the shortage if there’s a leaky bucket. It is critical that the government understands the pressures on GPs and acts on the retention challenges highlighted by this survey.”