title: GP views on strategies to cope with increasing workload: a qualitative interview study.
abstract: BACKGROUND
  The existence of a crisis in primary care in the UK is in little doubt. GP morale and job satisfaction are low, and workload is increasing. In this challenging context, finding ways for GPs to manage that workload is imperative.
  
  
  OBJECTIVE
  To explore what existing or potential strategies are described by GPs for dealing with their workload, and their views on the relative merits of each.
  
  
  METHODS
  Semi-structured, qualitative interviews with GPs working within NHS England.
  
  
  METHODS
  All GPs working within NHS England were eligible. Of those who responded to advertisements, a maximum-variation sample was selected and interviewed until data saturation was reached. Data were analysed thematically.
  
  
  RESULTS
  Responses were received from 171 GPs, and, from these, 34 were included in the study. Four main themes emerged for workload management: patient-level, GP-level, practice-level, and systems-level strategies. A need for patients to take greater responsibility for self-management was clear, but many felt that GPs should not be responsible for this education. Increased delegation of tasks was felt to be key to managing workload, with innovative use of allied healthcare professionals and extended roles for non-clinical staff suggested. Telephone triage was a commonly used tool for managing workload, although not all participants found this helpful.
  
  
  CONCLUSIONS
  This in-depth qualitative study demonstrates an encouraging resilience among GPs. They are proactively trying to manage workload, often using innovative local strategies. GPs do not feel that they can do this alone, however, and called repeatedly for increased recruitment and more investment in primary care.
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
authors.forename: Rebecca Fr
authors.initials: RF
authors.lastname: Fisher
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: D000223:Adaptation, Psychological; D001291:Attitude of Health Personnel; D058005:General Practitioners / Q000523:psychology; D006801:Humans; D007588:Job Satisfaction; D010558:Personnel Loyalty; D011320:Primary Health Care / Q000458:organization & administration; D036301:Qualitative Research; D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom; D016526:Workload / Q000523:psychology* / Q000706:statistics & numerical data
keywords: general practice; general practitioners; primary health care; qualitative research; workload