چکیده (انگلیسی):

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