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Crisis – what crisis? The reality of life in general practice in England by Professor Kath Checkland (Manchester University)

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Interesting article from The University of Manchesters Policy Blog written by Professor Kath Checkland

GPs are dealing with increased stress and more are leaving practice. Yet there are signs for optimism, reports Professor Kath Checkland.

GPs in the UK are fed up – this much is commonplace. Newspaper headlines and social media alike tell a tale of dissatisfaction, declining morale and intentions to quit.

If these reports are to be believed, general practice in the UK is in crisis, with a perfect storm of poor recruitment, emigration and early retirement. But how much of this is actually true? The Manchester Centre for Health Economics at the University of Manchester and the Policy Research Unit in Commissioning and the Healthcare System (PRUComm) have just published the findings from the 8th National GP Worklife Survey, providing important objective evidence of the issues and problems as seen by GPs themselves.

This survey series has now been conducted eight times since 1998. In 2015 the survey was conducted in the spring, with a random sample of GPs invited to reflect upon their experience of their working lives. The response rate was 46%, representing 2611 GPs.

Standard questions explore the aspects of their job which they find satisfying and the things which they find stressful. The survey also collects demographic information, working hours, contract type and income. Not only do the surveys capture repeated snapshots, but also a cohort of GPs have been completing the survey repeatedly for a number of years, providing a longitudinal picture of change over time for the same individuals.

So what does the survey show? As you might expect, the headline findings do suggest growing dissatisfaction – the highest level since 2001. Reported levels of stress have also increased on all 14 stressors, with increases generally in the range 0.2 to 0.5 points on a five-point scale. Reported levels of stress are now at their highest since the beginning of the National GP Worklife Survey series in 1998.

The most stressful aspects of work reported include increased workload, and the need to change what they do to meet the requirements of external bodies. GPs report having to work very intensively and there is some evidence in the survey of work intensification, with a trend towards worked sessions increasing slightly in length – staying late to finish the work. Poor publicity about general practice is also cited as being a source of stress.

Most worryingly, perhaps, intentions to quit have increased. The proportion of surveyed GPs expecting to quit direct patient care in the next five years has increased from 8.9% in 2012 to 13.1% in 2015 amongst GPs under 50 years-old. It has also increased – from 54.1% in 2012 to 60.9% in 2015 – amongst GPs aged 50 years and over.

However, there are also some grounds for hope. Job dissatisfaction is rising, but 47% of GPs are currently reporting that they are satisfied with their job overall, with 32% reporting themselves as being ‘dissatisfied’. This is bad, but not catastrophic.

When we look at which aspects of the job people find satisfying, physical working conditions, the amount of variety in the job, the opportunity to use one’s abilities, the amount of responsibility given and the freedom to choose one’s own method of working all show positive figures, with more than 60% of GPs reporting themselves to be satisfied. This suggests that the core attributes of general practice remain present and attractive, albeit under strain.

Satisfaction with working colleagues has increased, with 85% of GPs surveyed declaring themselves satisfied. This implies that practices are pulling together, supporting one another in the face of increasing pressure.

Is there a crisis? The survey definitely suggests that there are problems, and that the GP workforce is under increasing strain, but many aspects of the job remain satisfying. This is obviously something for those responsible for GP recruitment to focus upon. Finally, the survey provides evidence of those things which are most contributing to the strain, and this may be useful in targeting support for practices.


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