How can we improve GP recruitment and retention in areas of socio-economic deprivation? Qualitative evaluation of the Deep End GP Pioneer Scheme

Problem

There is a General practitioner (GP) workforce crisis across the UK, but there are particular challenges with GP recruitment and retention in areas of deprivation. General Practitioners at the Deep End work in the 100 general practices serving the most socioeconomically deprived populations in Scotland. The Deep End GP Pioneer Scheme, established in 2016 with funding from the Scottish Government, aimed to develop a sustainable model for primary health care delivery in deprived areas. It involved recruitment of early career GPs (5 GP fellows in the first cohort, 7 in the second), retention of experienced GPs and joint working on service and professional development (with protected time for both). The aim of this qualitative study was to explore the views and experiences of GP fellows and lead GPs from the Pioneer Scheme to help evaluate the extent to which the scheme met its intended aims.

Approach

GPs involved in the Pioneer Scheme (n=29; 12 GP fellows and 17 lead GPs) were invited to participate by email. Semi-structured interviews were conducted with 18 participants (10 GP fellows and 8 lead GPs), using a topic guide which included questions about motivation for applying to the Pioneer Scheme, strengths and limitations of the Scheme, factors influencing job satisfaction, and future plans. Interviews were audio-recorded and transcribed verbatim, then coded using NVIVO software. A sample of coding was checked with a second researcher. Reflexive thematic analysis was employed as a methodology for analysis.

Findings

GP fellows were attracted to the Pioneer Scheme because of protected time for learning, peer support, and mentoring from lead GPs. Lead GPs were attracted by the increased clinical capacity, enthusiasm of GP fellows, and protected time for service development work. Participants reported an increase in intrinsic aspects of job motivation/satisfaction including purpose, relatedness, mastery and autonomy as well as an increased readiness to work in deprived areas. Positive yet unanticipated outcomes included an improvement in GP wellbeing and increased creativity. Participants were critical of the short-term nature of the scheme and many were therefore skeptical of its ability to impact health inequalities due to lack of sustainability. All GP fellows expressed a future desire to work in Deep End practices as well as feeling more equipped to do so after completing the Pioneer Scheme.

Consequences

The Pioneer Scheme is a promising model for increasing recruitment and retention of GPs in areas of socio-economic deprivation, which has the potential to be scaled up as a new way of working in primary care, with protected time for service and professional development. Indeed, the Pioneer Scheme has already inspired a similar programme of health equity-oriented GP Fellowships (Fairhealth Trailblazer Scheme), which is being rolled out across England.