scholarly journals Policies and strategies to retain and support the return of experienced GPs in direct patient care: the ReGROUP mixed-methods study

2019 ◽  
Vol 7 (14) ◽  
pp. 1-288 ◽  
Author(s):  
John L Campbell ◽  
Emily Fletcher ◽  
Gary Abel ◽  
Rob Anderson ◽  
Rupatharshini Chilvers ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
General Practice ◽  
Mixed Methods ◽  
Patient Care ◽  
Mixed Methods Study ◽  
Direct Patient Care ◽  
South West ◽  
Career Break ◽  
South West England

BackgroundUK general practice faces a workforce crisis, with general practitioner (GP) shortages, organisational change, substantial pressures across the whole health-care system and an ageing population with increasingly complex health needs. GPs require lengthy training, so retaining the existing workforce is urgent and important.Objectives(1) To identify the key policies and strategies that might (i) facilitate the retention of experienced GPs in direct patient care or (ii) support the return of GPs following a career break. (2) To consider the feasibility of potentially implementing those policies and strategies.DesignThis was a comprehensive, mixed-methods study.SettingThis study took place in primary care in England.ParticipantsGeneral practitioners registered in south-west England were surveyed. Interviews were with purposively selected GPs and primary care stakeholders. A RAND/UCLA Appropriateness Method (RAM) panel comprised GP partners and GPs working in national stakeholder organisations. Stakeholder consultations included representatives from regional and national groups.Main outcome measuresSystematic review – factors affecting GPs’ decisions to quit and to take career breaks. Survey – proportion of GPs likely to quit, to take career breaks or to reduce hours spent in patient care within 5 years of being surveyed. Interviews – themes relating to GPs’ decision-making. RAM – a set of policies and strategies to support retention, assessed as ‘appropriate’ and ‘feasible’. Predictive risk modelling – predictive model to identify practices in south-west England at risk of workforce undersupply within 5 years. Stakeholder consultation – comments and key actions regarding implementing emergent policies and strategies from the research.ResultsPast research identified four job-related ‘push’ factors associated with leaving general practice: (1) workload, (2) job dissatisfaction, (3) work-related stress and (4) work–life balance. The survey, returned by 2248 out of 3370 GPs (67%) in the south-west of England, identified a high likelihood of quitting (37%), taking a career break (36%) or reducing hours (57%) within 5 years. Interviews highlighted three drivers of leaving general practice: (1) professional identity and value of the GP role, (2) fear and risk associated with service delivery and (3) career choices. The RAM panel deemed 24 out of 54 retention policies and strategies to be ‘appropriate’, with most also considered ‘feasible’, including identification of and targeted support for practices ‘at risk’ of workforce undersupply and the provision of formal career options for GPs wishing to undertake portfolio roles. Practices at highest risk of workforce undersupply within 5 years are those that have larger patient list sizes, employ more nurses, serve more deprived and younger populations, or have poor patient experience ratings. Actions for national organisations with an interest in workforce planning were identified. These included collection of data on the current scope of GPs’ portfolio roles, and the need for formal career pathways for key primary care professionals, such as practice managers.LimitationsThe survey, qualitative research and modelling were conducted in one UK region. The research took place within a rapidly changing policy environment, providing a challenge in informing emergent policy and practice.ConclusionsThis research identifies the basis for current concerns regarding UK GP workforce capacity, drawing on experiences in south-west England. Policies and strategies identified by expert stakeholders after considering these findings are likely to be of relevance in addressing GP retention in the UK. Collaborative, multidisciplinary research partnerships should investigate the effects of rolling out some of the policies and strategies described in this report.Study registrationThis study is registered as PROSPERO CRD42016033876 and UKCRN ID number 20700.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Why do GPs leave direct patient care and what might help to retain them? A qualitative study of GPs in South West England

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e019849 ◽  
Author(s):  
Anna Sansom ◽  
Rohini Terry ◽  
Emily Fletcher ◽  
Chris Salisbury ◽  
Linda Long ◽  
...  
Keyword(s):  
General Practice ◽  
Patient Care ◽  
Early Retirement ◽  
Direct Patient Care ◽  
Individual Interviews ◽  
South West ◽  
Career Break ◽  
Medical Litigation ◽  
The Uk ◽  
South West England

ObjectiveTo identify factors influencing general practitioners' (GPs’) decisions about whether or not to remain in direct patient care in general practice and what might help to retain them in that role.DesignQualitative, in-depth, individual interviews exploring factors related to GPs leaving, remaining in and returning to direct patient care.SettingSouth West England, UK.Participants41 GPs: 7 retired; 8 intending to take early retirement; 11 who were on or intending to take a career break; 9 aged under 50 years who had left or were intending to leave direct patient care and 6 who were not intending to leave or to take a career break. Plus 19 stakeholders from a range of primary care-related professional organisations and roles.ResultsReasons for leaving direct patient care were complex and based on a range of job-related and individual factors. Three key themes underpinned the interviewed GPs’ thinking and rationale: issues relating to their personal and professional identity and the perceived value of general practice-based care within the healthcare system; concerns regarding fear and risk, for example, in respect of medical litigation and managing administrative challenges within the context of increasingly complex care pathways and environments; and issues around choice and volition in respect of personal social, financial, domestic and professional considerations. These themes provide increased understanding of the lived experiences of working in today’s National Health Service for this group of GPs.ConclusionFuture policies and strategies aimed at retaining GPs in direct patient care should clarify the role and expectations of general practice and align with GPs’ perception of their own roles and identity; demonstrate to GPs that they are valued and listened to in planning delivery of the UK healthcare; target GPs’ concerns regarding fear and risk, seeking to reduce these to manageable levels and give GPs viable options to support them to remain in direct patient care.

scholarly journals Identifying patients at risk of psychosis: a qualitative study of GP views in South West England

2020 ◽  
pp. bjgp20X713969
Author(s):  
Daniela Strelchuk ◽  
Nicola Wiles ◽  
Catherine Derrick ◽  
Stanley Zammit ◽  
Katrina Turner
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Patient Group ◽  
Continuity Of Care ◽  
Mental State ◽  
Psychotic Symptoms ◽  
Structured Interviews ◽  
South West ◽  
South West England ◽  
At Risk Mental State

BackgroundEarly intervention in people with an at-risk mental state for psychosis can decrease the rates of transition to psychosis. GPs play a key role in the identification of this patient group but very few studies have explored GPs’ awareness of patients who are at risk of psychosis.AimTo explore GPs’ views and experiences of identifying patients with an at-risk mental state for psychosis, and the barriers and facilitators to identification.Design and settingIn-depth semi-structured interviews were held with GPs working in South West England primary care. The interviews were conducted between March and July 2019.MethodA topic guide was used to ensure consistency across interviews. This guide was revised to incorporate a definition of the at-risk mental state for psychosis, as after conducting a few interviews it became clear that some GPs were not familiar with this construct. Interviews were audiorecorded and analysed thematically.ResultsA total of 20 GPs were interviewed. Some GPs were not familiar with the concept of being at risk of developing psychosis, and perceived that they may not have the right skills to identify this patient group. Other barriers related to patients not presenting or disclosing psychotic symptoms, and limitations imposed by scarce resources on the structure and provision of NHS services, such as lack of continuity of care and high thresholds for accessing specialised services.ConclusionIdentifying people at risk of psychosis in primary care is difficult. Provision of GP training, development of policies that support continuity of care, and improved access to specialised services could help improve the identification of this patient group.

Identifying people with type 2 diabetes and those at risk: Lessons from the Measure Your Waist (MY-WAIST) mixed-methods study in UK primary care

2013 ◽  
Vol 7 (4) ◽  
pp. 261-267 ◽  
Author(s):  
Navneet Aujla ◽  
Margaret A. Stone ◽  
Nicholas Taub ◽  
Melanie J. Davies ◽  
Kamlesh Khunti
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
At Risk ◽  
Mixed Methods ◽  
Mixed Methods Study

scholarly journals A mixed methods study to compare models of spirometry delivery in primary care for patients at risk of COPD

Thorax ◽  
2008 ◽  
Vol 63 (5) ◽  
pp. 408-414 ◽  
Author(s):  
J A Walters ◽  
E C Hansen ◽  
D P Johns ◽  
E L Blizzard ◽  
E H Walters ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Mixed Methods ◽  
Mixed Methods Study ◽  
Patients At Risk

scholarly journals Quitting patient care and career break intentions among general practitioners in South West England: findings of a census survey of general practitioners

BMJ Open ◽  
2017 ◽  
Vol 7 (4) ◽  
pp. e015853 ◽  
Author(s):  
Emily Fletcher ◽  
Gary A Abel ◽  
Rob Anderson ◽  
Suzanne H Richards ◽  
Chris Salisbury ◽  
...  
Keyword(s):  
Patient Care ◽  
General Practitioners ◽  
South West ◽  
Career Break ◽  
South West England

scholarly journals An Exploratory Mixed Methods Study of Experiences of Interprofessional Teams Who Received Coaching to Simultaneously Redesign Primary Care Education and Clinical Practice

2021 ◽  
Vol 12 ◽  
pp. 215013272110237
Author(s):  
Patricia A. Carney ◽  
W. Perry Dickinson ◽  
Jay Fetter ◽  
Eric J. Warm ◽  
Brenda Zierler ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Mixed Methods Study ◽  
Local Context ◽  
Primary Care Residency ◽  
Interprofessional Teams ◽  
Coaching Relationship ◽  
Team Coaching ◽  
Primary Care Education ◽  
Health Coaches

Introduction/Objectives: Coaching is emerging as a form of facilitation in health professions education. Most studies focus on one-on-one coaching rather than team coaching. We assessed the experiences of interprofessional teams coached to simultaneously improve primary care residency training and interprofessional practice. Methods: This three-year exploratory mixed methods study included transformational assistance from 9 interprofessional coaches, one assigned to each of 9 interprofessional primary care teams that included family medicine, internal medicine, pediatrics, nursing, pharmacy and behavioral health. Coaches interacted with teams during 2 in-person training sessions, an in-person site visit, and then as requested by their teams. Surveys administered at 1 year and end study assessed the coaching relationship and process. Results: The majority of participants (82% at end of Year 1 and 76.6% at end study) agreed or strongly agreed that their coach developed a positive working relationship with their team. Participants indicated coaches helped them: (1) develop as teams, (2) stay on task, and (3) respond to local context issues, with between 54.3% and 69.2% agreeing or strongly agreeing that their coaches were helpful in these areas. Cronbach’s alpha for the 15 coaching survey items was 0.965. Challenges included aligning the coach’s expertise with the team’s needs. Conclusions: While team coaching was well received by interprofessional teams of primary care professionals undertaking educational and clinical redesign, the 3 primary care disciplines have much to learn from each other regarding how to improve inter- and intra-professional collaborative practice among clinicians and staff as well as with interprofessional learners rotating through their outpatient clinics.

scholarly journals Engaging primary care providers in managing pediatric eating disorders: a mixed methods study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Jocelyn Lebow ◽  
Cassandra Narr ◽  
Angela Mattke ◽  
Janna R. Gewirtz O’Brien ◽  
Marcie Billings ◽  
...  
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
Mixed Methods ◽  
Care Setting ◽  
Primary Care Setting ◽  
Primary Care Providers ◽  
Mixed Methods Study ◽  
Evidence Based ◽  
Care Providers ◽  
Evidence Based Treatment

Abstract Background The primary care setting offers an attractive opportunity for, not only the identification of pediatric eating disorders, but also the delivery of evidence-based treatment. However, constraints of this setting pose barriers for implementing treatment. For interventions to be successful, they need to take into consideration the perspectives of stakeholders. As such, the purpose of this study was to examine in-depth primary care providers’ perspective of challenges to identifying and managing eating disorders in the primary care setting. Methods This mixed methods study surveyed 60 Pediatric and Family Medicine providers across 6 primary care practices. Sixteen of these providers were further interviewed using a qualitative, semi-structured interview. Results Providers (n = 60, response rate of 45%) acknowledged the potential of primary care as a point of contact for early identification and treatment of pediatric eating disorders. They also expressed that this was an area of need in their practices. They identified numerous barriers to successful implementation of evidence-based treatment in this setting including scarcity of time, knowledge, and resources. Conclusions Investigations seeking to build capacities in primary care settings to address eating disorders must address these barriers.

scholarly journals Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: A mixed methods study

AIDS Care ◽  
2013 ◽  
Vol 25 (7) ◽  
pp. 874-880 ◽  
Author(s):  
Larry W. Chang ◽  
Veronica Njie-Carr ◽  
Sheila Kalenge ◽  
Jack F. Kelly ◽  
Robert C. Bollinger ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Patient Care ◽  
Mixed Methods Study ◽  
Community Based ◽  
Improving Patient Care ◽  
Hiv Aids

scholarly journals Challenges to implementation of developmental screening in urban primary care: a mixed methods study

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Deanna L Morelli ◽  
Susmita Pati ◽  
Anneliese Butler ◽  
Nathan J Blum ◽  
Marsha Gerdes ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Mixed Methods Study ◽  
Developmental Screening
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