Coping with General Practice: An exploratory study of the working life of General Practitioners in 2017

Problem

Whilst it is recognised that health policy is changing the shape and direction of primary care, an expert generalist role is still required in the system to help meet the breadth of clinical challenges posed. At the same time, the NHS is finding it difficult to recruit and retain sufficient General Practitioners (GPs) who wish to do patient facing work This was a study of GPs working in England in 2017. It aimed to explore both nature of the demands of their role as well as the support mechanisms available and how these GP s managed the demands of their work.

Approach

As the researcher is a GP, participants were recruited using a Snowball/Respondent driven sampling strategy. Data was gathered using a series of semi-structured telephone interviews which were transcribed. Semi-structured interviews were chosen to allow the respondents to provide depth of information about attitudes and experiences as well as to permit expression of feelings and opinions.A critical realist approach informed the approach to this study. Framework analysis was used for data management and analysis. A matrix of five overarching themes was identified.

Findings

Interviews with 12 Drs were completed. This sample included salaried Drs and partners practising across England. Five worked full-time and the others part-time. Their primary medical qualifications had been gained (between 1970 and 2012) in the UK, India, Europe and South Africa, mirroring the range seen in GMC workforce data. The five major themes identified were: Health Policy impacts, Changes in the external environment, Dealing with Complexity, Uncertainty in a changing system, Impact on the individual doctor's stress and coping mechanisms (including moderating and mediating factors).

Consequences

This group of doctors was acutely aware of the service re-organisation taking place around them. For the majority, promised increased resources had not materialised and workload was rising inexorably.The interview findings are discussed in the context of stress and coping. The final theme operates in a similar fashion to that described in the Job Demands-Resources model (Schaufeli and Bakker).An overarching consideration is ‘eudaemonic’ well-being, several were experiencing anhedonia and feeling of being ‘chronically sub-burnout’. There appeared to be significant deficits in core dimensions of well-being as well as a sense of ‘moral distress’. Jameton warns that failure to recognise this or acknowledge these experiences had devastating effects on both the individual and the services they provide. The findings of this study will be used to inform a questionnaire study of stress and coping in a larger sample of GPs in England, considering whether particular characteristics of the doctor or their working environment are related to burnout. These finding may inform workplace changes aimed at ameliorating the current workforce crisis.