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stethoscopJanuary 13 2016

Organisational changes in the NHS and increasing bureaucracy are significant factors contributing to GPs’ decreasing job satisfaction, a study had concluded.

A perceived increase in administrative tasks and overall workload in recent years has “fundamentally changed the doctor-patient relationship,” said the study. Its results were compiled from an online and telephone survey of 143 doctors aged under 50 who had left general practice since 2009.

“Lack of time with patients has compromised the ability to practise more patient-centred care, and, with it, GPs’ sense of professional autonomy and values, resulting in diminished job satisfaction,” concluded the study authors. “In this context, the additional pressures of increased patient demand and the negative media portrayal left many feeling unsupported and vulnerable to burnout and ill health, and, ultimately, to the decision to leave general practice.”

The researchers say that to improve GP retention, the pace of administrative change should be minimised and that the amount of time GPs spend on work which is not face-to-face patient care should also be reduced.

The study appears in the latest edition of the British Journal of General Practice which also carries a paper looking at what aspects of general practice have continued to motivate and engage GPs in practice. The findings of the qualitative study are based on open interviews conducted with eight senior GPs who had qualified in the early 1980s.

“During interviews in which doctors drew on a wide range of encounters and experiences, they revealed which aspects of work were associated with greater intrinsic rewards and contributed to their continuing motivation,” said the study author, Sharon Spooner.

Important aspects were the ability to interact with patients, the support from working in teams, including the benefits of informal catch-up sessions such as coffee breaks, the introduction of the new contract in 2004, and the ability to achieve targets such as reducing prescribing costs.

“Long-term engagement of practitioners may be achieved through provision of adequate supportive resources to allow them to enact a sense of medical identity that matches with their acquired expectations of their role in the NHS,” concluded Dr Spooner.

Responding to the BJGP papers, Dr Tim Ballard, RCGP Vice Chair, said: “The amount of red tape and bureaucracy that GPs and our teams are facing is overwhelming, and as this research shows, it is driving family doctors to leave our profession at a time when we should be doing everything possible to retain them.

“With more and more of our working hours being taken up with form-filling, ticking boxes and preparing for CQC practice inspections, we are drowning in red tape and this only serves to keep us away from delivering frontline patient care, which is why we become doctors in the first place.”

He pointed out that GPs and their teams will make in excess of 370 million patient consultations this year, 60 million more than five years ago “yet the resources we have available to us have been decreasing and the number of family doctors has remained relatively stagnant.”

Dr Richard Vautrey, BMA GP Committee deputy chair, said that many GPs “are drowning in pointless paperwork which takes them away from what they want to do: treat patients.

“There is an urgent need for a proper occupational health service to support the increasing number of GPs suffering from the effects of stress and burnout. The government also needs to produce a long term, sustainable plan for general practice that gives the entire service the resources it needs to deliver the care patients deserve.”

Links:

British Journal of General Practice

N Doran et al. ‘Lost to the NHS: a mixed methods study of why GPs leave practice early in England’. BJGP. Published online Jan 7 2016

S Spooner. ‘Unfashionable tales: narratives about what is (still) great in NHS general practice’. BJGP. Published online Jan 7 2016

RCGP response

BMA response 

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