title: GPs' perceptions of workload in England: a qualitative interview study.
abstract: BACKGROUND
  GPs report the lowest levels of morale among doctors, job satisfaction is low, and the GP workforce is diminishing. Workload is frequently cited as negatively impacting on commitment to a career in general practice, and many GPs report that their workload is unmanageable.
  
  
  OBJECTIVE
  To gather an in-depth understanding of GPs' perceptions and attitudes towards workload.
  
  
  METHODS
  All GPs working within NHS England were eligible. Advertisements were circulated via regional GP e-mail lists and national social media networks in June 2015. Of those GPs who responded, a maximum-variation sample was selected until data saturation was reached.
  
  
  METHODS
  Semi-structured, qualitative interviews were conducted. Data were analysed thematically.
  
  
  RESULTS
  In total, 171 GPs responded, and 34 were included in this study. GPs described an increase in workload over recent years, with current working days being long and intense, raising concerns over the wellbeing of GPs and patients. Full-time partnership was generally not considered to be possible, and many participants felt workload was unsustainable, particularly given the diminishing workforce. Four major themes emerged to explain increased workload: increased patient needs and expectations; a changing relationship between primary and secondary care; bureaucracy and resources; and the balance of workload within a practice. Continuity of care was perceived as being eroded by changes in contracts and working patterns to deal with workload.
  
  
  CONCLUSIONS
  This study highlights the urgent need to address perceived lack of investment and clinical capacity in general practice, and suggests that managing patient expectations around what primary care can deliver, and reducing bureaucracy, have become key issues, at least until capacity issues are resolved.
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
authors.forename: Caroline Hd
authors.initials: CH
authors.lastname: Croxson
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
authors.forename: Helen F
authors.initials: HF
authors.lastname: Ashdown
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
authors.forename: Fd Richard
authors.initials: FR
authors.lastname: Hobbs
mesh_terms: D001291:Attitude of Health Personnel; D032982:Contracts; D004739:England; D058006:General Practice / Q000592:standards; D058005:General Practitioners / Q000523:psychology*; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D007588:Job Satisfaction; D036301:Qualitative Research; D000078329:Workforce; D016526:Workload / Q000523:psychology* / Q000706:statistics & numerical data
keywords: general practice; general practitioners; patient expectations; patients’ needs; primary health care; qualitative research; workload