title: Retaining the general practitioner workforce in England: what matters to GPs? A cross-sectional study.
abstract: BACKGROUND
  The general practice (GP) workforce in England is in crisis, reflected in increasing rates of early retirement and intentions to reduce hours of working. This study aimed to investigate underlying factors and how these might be mitigated.
  
  
  METHODS
  GPs in central England were invited to participate in an on-line survey exploring career plans and views and experiences of work-related pressures. Quantitative data were analysed using logistic regression analysis and principal components analysis. Qualitative data were analysed using a thematic framework approach.
  
  
  RESULTS
  Of 1,192 GPs who participated, 978 (82.0 %) stated that they intend to leave general practice, take a career break and/or reduce clinical hours of work within the next five years. This included 488 (41.9 %) who intend to leave practice, and almost a quarter (279; 23.2 %) intending to take a career break. Only 67 (5.6 %) planned to increase their hours of clinical work. For participants planning to leave practice, the issues that most influenced intentions were volume and intensity of workload, time spent on "unimportant tasks", introduction of seven-day working and lack of job satisfaction. Four hundred fifty five participants responded to open questions (39128 words in total). The main themes were the cumulative impact of work-related pressures, the changing and growing nature of the workload, and the consequent stress. Reducing workload intensity, workload volume, administrative activities, with increased time for patient care, no out-of-hour commitments, more flexible working conditions and greater clinical autonomy were identified as the most important requirements to address the workforce crisis. In addition, incentive payments, increased pay and protected time for education and training were also rated as important.
  
  
  CONCLUSIONS
  New models of professionalism and organisational arrangements may be needed to address the issues described here. Without urgent action, the GP workforce crisis in England seems set to worsen.
authors.affiliation: Warwick Medical School, Coventry, CV4 7AL, UK. jeremy.dale@warwick.ac.uk.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Dale
authors.affiliation: Warwick Medical School, Coventry, CV4 7AL, UK. r.potter@warwick.ac.uk.
authors.forename: Rachel
authors.initials: R
authors.lastname: Potter
authors.affiliation: Warwick Medical School, Coventry, CV4 7AL, UK. katherine.owen@warwick.ac.uk.
authors.forename: Katherine
authors.initials: K
authors.lastname: Owen
authors.affiliation: Warwick Medical School, Coventry, CV4 7AL, UK. nick.parsons@warwick.ac.uk.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Parsons
authors.affiliation: Warwick Medical School, Coventry, CV4 7AL, UK. a.x.realpe@warwick.ac.uk.
authors.forename: Alba
authors.initials: A
authors.lastname: Realpe
authors.affiliation: Davenal House Surgery, Bromsgrove, Worcestershire, B61 0DD, UK. jonathanleach@jonathanleach.net.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Leach
mesh_terms: D003430:Cross-Sectional Studies; D004739:England; D005260:Female; D058005:General Practitioners / Q000458:organization & administration / Q000523:psychology* / Q000600:supply & distribution; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D010561:Personnel Staffing and Scheduling; D010563:Personnel Turnover; D011795:Surveys and Questionnaires; D016526:Workload