title: Lost to the NHS: a mixed methods study of why GPs leave practice early in England.
abstract: BACKGROUND
  The loss of GPs in the early stages of their careers is contributing to the GP workforce crisis. Recruitment in the UK remains below the numbers needed to support the demand for GP care.
  
  
  OBJECTIVE
  To explore the reasons why GPs leave general practice early.
  
  
  METHODS
  A mixed methods study using online survey data triangulated with qualitative interviews.
  
  
  METHODS
  Participants were GPs aged <50 years who had left the English Medical Performers List in the last 5 years (2009-2014). A total of 143 early GP leavers participated in an online survey, of which 21 took part in recorded telephone interviews. Survey data were analysed using descriptive statistics, and qualitative data using thematic analysis techniques.
  
  
  RESULTS
  Reasons for leaving were cumulative and multifactorial. Organisational changes to the NHS have led to an increase in administrative tasks and overall workload that is perceived by GP participants to have fundamentally changed the doctor-patient relationship. Lack of time with patients has compromised the ability to practise more patient-centred care, and, with it, GPs' sense of professional autonomy and values, resulting in diminished job satisfaction. In this context, the additional pressures of increased patient demand and the negative media portrayal left many feeling unsupported and vulnerable to burnout and ill health, and, ultimately, to the decision to leave general practice.
  
  
  CONCLUSIONS
  To improve retention of young GPs, the pace of administrative change needs to be minimised and the time spent by GPs on work that is not face-to-face patient care reduced.
authors.affiliation: Department for Health, University of Bath, Bath; senior research fellow, South West Academic Health Science Network (SWAHSN), Exeter.
authors.forename: Natasha
authors.initials: N
authors.lastname: Doran
authors.affiliation: NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) West, University of Bristol, Bristol.
authors.forename: Fiona
authors.initials: F
authors.lastname: Fox
authors.affiliation: Staffordshire University, Stoke-on-Trent.
authors.forename: Karen
authors.initials: K
authors.lastname: Rodham
authors.affiliation: Department for Health, University of Bath, Bath.
authors.forename: Gordon
authors.initials: G
authors.lastname: Taylor
authors.affiliation: Department for Health, University of Bath, Bath.
authors.forename: Michael
authors.initials: M
authors.lastname: Harris
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D004739:England; D005260:Female; D058006:General Practice / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017009:Professional Autonomy; D013222:State Medicine / Q000458:organization & administration*; D011795:Surveys and Questionnaires
keywords: burnout; general practice; job satisfaction; professional autonomy; qualitative research; workload