Multimorbidity Plus: exploring GP work in deprived areas

Problem

There is a recruitment crisis in General Practice, particularly in deprived areas. We know that GPs working in deprived areas manage more complex multimorbidity in less time. What is less well recognised is that alongside medical complexity, GPs are also increasingly managing attendant social complexity. The extra workload created could be contributing to the recruitment crisis.We wanted to look in more depth at the evolving GP workload in multiply disadvantaged communities. In particular, we sought to explore the work involved in managing this combination of medical and social complexity, and the extent to which the skills required deviate from the conventional GP role. Studies of chronic illness suggest patients engage in different types or ‘lines’ of work. Corbin and Strauss’ influential portrayal of living with chronic illness identified three lines of work: biographical, everyday and illness work. Drawing on Corbin and Strauss’ theory as an analytic lens, we explored the lines of work carried out by GPs working in areas of multiple disadvantage.

Approach

We carried out a secondary analysis of ten in-depth interviews with GPs working in areas of multiple disadvantage. The original study focused on GP engagement in training in areas of deprivation. Initial analysis of the transcripts highlighted the issue of GP work and work roles. Corbin and Strauss’ theory emerged as a potentially relevant analytic tool; a coding frame based on the lines of work was applied to the data

Findings

Hidden (everyday) work: while much of their everyday work was similar to all GPs, the respondents identified significant extra work created from managing populations with low health literacy, low self-efficacy and the burden of poverty. Frustration with this extra work - often viewed as the most challenging aspect of their role - was expressed, particularly that it was neither recognised, nor rewarded, by the wider health system.Role of the GP: a biographical challenge: Some GPs struggled with demands of patients and professionals, to manage issues they felt outwith their remit and not what they were trained for. Their identity as GPs was challenged constantly.Tension between everyday and biographical work: Other GPs had reframed their biography, seeing managing social problems, advocacy and navigating the health system for their patients as a core part of their role, ultimately absorbed into everyday work.Illness work and overwhelmed patients: GPs described a more active role, for the wider primary care team, in management of chronic illness in the context of patients who were often overwhelmed.

Consequences

These findings suggest substantial, often hidden, work that is not recognised, or resourced, in deprived areas. Recognising and resourcing this work could increase GP resilience and reduce burnout. Our findings contribute to the wider discourse on the crisis in primary care