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 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 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

TBE in United Kingdom

2020 ◽  
Keyword(s):  
United Kingdom ◽  
Clinical Disease ◽  
England And Wales ◽  
Probable Case ◽  
The United Kingdom ◽  
South West ◽  
Louping Ill ◽  
The Uk ◽  
North And South ◽  
South West England

Until 2019, TBE was considered only to be an imported disease to the United Kingdom. In that year, evidence became available that the TBEV is likely circulating in the country1,2 and a first “probable case” of TBE originating in the UK was reported.3 In addition to TBEV, louping ill virus (LIV), a member of the TBEV-serocomplex, is also endemic in parts of the UK. Reports of clinical disease caused by LIV in livestock are mainly from Scotland, parts of North and South West England and Wales.4

scholarly journals Internal Medicine Residents' Time Study: Paperwork Versus Patient Care

2011 ◽  
Vol 3 (4) ◽  
pp. 550-553 ◽  
Author(s):  
Dalal Alromaihi ◽  
Amanda Godfrey ◽  
Tina Dimoski ◽  
Paul Gunnels ◽  
Eric Scher ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Health Care ◽  
General Practice ◽  
Patient Care ◽  
Health Care Workers ◽  
Direct Patient Care ◽  
Time Study ◽  
Structured Education ◽  
Internal Medicine Residents ◽  
Care Workers

Abstract Background Multiple factors affect residency education, including duty-hour restrictions and documentation requirements for regulatory compliance. We designed a work sampling study to determine the proportion of time residents spend in structured education, direct patient care, indirect patient care that must be completed by a physician, indirect patient care that may be delegated to other health care workers, and personal activities while on an inpatient general practice unit. Methods The 3-month study in 2009 involved 14 categorical internal medicine residents who volunteered to use personal digital assistants to self-report their location and primary tasks while on an inpatient general practice unit. Results Residents reported spending most of their time at workstations (43%) and less time in patient rooms (20%). By task, residents spent 39% of time on indirect patient care that must be completed by a physician, 31% on structured education, 17% on direct patient care, 9% on indirect patient care that may be delegated to other health care workers, and 4% on personal activities. From these data we estimated that residents spend 34 minutes per patient per day completing indirect patient care tasks compared with 15 minutes per patient per day in direct patient care. Conclusions This single-institution time study objectively quantified a current state of how and where internal medicine residents spend their time while on a general practice unit, showing that residents overall spend less time on direct patient care compared with other activities.

scholarly journals Exploring the basis for parents’ negative reactions to being informed that their child is overweight

2013 ◽  
Vol 17 (5) ◽  
pp. 987-997 ◽  
Author(s):  
Fiona Gillison ◽  
Fay Beck ◽  
Joanna Lewitt
Keyword(s):  
Local Authority ◽  
Service Providers ◽  
Healthy Lifestyle ◽  
Postal Questionnaire ◽  
Parenting Skills ◽  
Parental Awareness ◽  
South West ◽  
The Uk ◽  
Qualitative Responses ◽  
South West England

AbstractObjectiveIncreasing parental awareness of childhood obesity is an important part of tackling the issue. However, parents’ negative reactions to being informed that their children are overweight or obese can hinder their engagement with relevant services. The present study aimed to develop a deeper understanding of why parents react negatively, to help commissioners and service providers design services that are more acceptable to them.DesignOpen, qualitative responses to a survey were collected using a postal questionnaire. Responses were analysed using content analysis.SettingOne local authority in south-west England.SubjectsThe sample frame included all parents receiving letters informing them that their child was overweight (91st–98th centile) or very overweight (98th–100th centile) through the UK National Child Measurement Programme in 2012.ResultsForty-five of 313 eligible parents (14 %) responded to the survey, of whom forty-three rejected either to the judgement that their child was overweight and/or being provided with this feedback. Primary reasons for objection included: lack of trust in the measures used, lack of belief that being overweight is important for children's health (relative to a healthy lifestyle), and fear that discussing weight with children will trigger eating disorders. In addition, parents’ responses suggested that they considered receiving this feedback to be a criticism of their parenting skills.ConclusionsOverall, three areas for improving communication with parents were suggested: tailoring letters; providing information about the importance of weight independently of lifestyle; and addressing parents’ concerns about the risks of talking to children about their weight.

Equine viral arteritis: not just a reproductive disease

2019 ◽  
Vol 184 (26) ◽  
pp. 791-793
Keyword(s):  
Equine Viral Arteritis ◽  
South West ◽  
Reproductive Services ◽  
Reproductive Disease ◽  
The Uk ◽  
South West England

Following the recent confirmation of cases of equine viral arteritis in stallions in south-west England, James Crabtree of Equine Reproductive Services (UK) discusses the disease and its potential routes of spread into and around the UK.

Reptile-associated salmonellosis in children aged under 5 years in South West England

2014 ◽  
Vol 100 (4) ◽  
pp. 364-365 ◽  
Author(s):  
Dan Murphy ◽  
Femi Oshin
Keyword(s):  
Public Health ◽  
Severity Of Illness ◽  
Invasive Disease ◽  
Exposure Age ◽  
South West ◽  
Health Authorities ◽  
Public Health Authorities ◽  
The Uk ◽  
South West England ◽  
Children Under 5

ObjectiveTo determine the proportion of Salmonella cases in children aged <5 years that were reptile-associated salmonellosis (RAS) and to compare the severity of illness.DesignTo analyse all cases of salmonellosis reported to public health authorities in children aged under 5 years in the South West of the UK from January 2010 to December 2013 for reptile exposure, age, serotype, hospitalisation and invasive disease.Results48 of 175 (27%) Salmonella cases had exposure to reptiles. The median age of RAS cases was significantly lower than non-RAS cases (0.5 vs 1.0 year). RAS cases were 2.5 times more likely to be hospitalised (23/48) compared with non-RAS cases (25/127; p=0.0002). This trend continued in cases aged under 12 months, with significantly more RAS cases hospitalised (19/38) than non-RAS cases (8/42; p=0.003). Significantly more RAS cases had invasive disease (8/48: 5 bacteraemia, 2 meningitis, 1 colitis) than non-RAS cases (4/127: 3 bacteraemia, 1 meningitis).ConclusionsReptile exposure was found in over a quarter of all reported Salmonella cases in children under 5 years of age. RAS is associated with young age, hospitalisation and invasive disease.

scholarly journals A socio-ecological perspective on behavioural interventions to influence food choice in schools: alternative, complementary or synergistic?

2013 ◽  
Vol 16 (6) ◽  
pp. 1000-1005 ◽  
Author(s):  
Laurence Moore ◽  
Andrea de Silva-Sanigorski ◽  
Sue N Moore
Keyword(s):  
Case Studies ◽  
Food Choice ◽  
School Food ◽  
Behavioural Interventions ◽  
South West ◽  
Alternative Approaches ◽  
Multiple Levels ◽  
The Uk ◽  
South West England

AbstractObjectiveAn increasing focus on legislation, policy and guidance on the nutritional content of school food has in part been in response to the limited impact of more behavioural or educational approaches. However, there is a risk that a sole focus on policy-level action may lead to neglect of the important contribution that more behavioural approaches can make as components of effective, coordinated, multilevel action to improve the dietary intake of schoolchildren. The current paper aims to highlight the potential importance of viewing alternative approaches as complementary or synergistic, rather than competing.DesignThe socio-ecological and RE-AIM frameworks are used to provide a theoretical rationale and demonstrate the importance of explicitly identifying the interdependence of policies, interventions and contextual structures and processes. School food case study evidence is used to exemplify how understanding and exploiting these interdependencies can maximise impact on dietary outcomes.SettingCase studies of trials in schools in the UK (South West England and Wales) and Australia (Victoria).SubjectsSchoolchildren.ResultsThe case studies provide examples to support the hypothesis that the reach, effectiveness, adoption, implementation and maintenance of school food policies and interventions can be maximised by understanding and exploiting the interdependence between levels in the socio-ecological framework.ConclusionsRather than being seen as competing alternatives, diverse approaches to improving the diets of schoolchildren should be considered in terms of their potential to be complementary and synergistic, acting at multiple levels to improve acceptability, fidelity, effectiveness and sustainability.

scholarly journals Does applicant specialty ambition influence medical school choice?

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703685
Author(s):  
Eliot Rees ◽  
David Harrison ◽  
Karen Mattick ◽  
Katherine Woolf
Keyword(s):  
General Practice ◽  
School Choice ◽  
Medical School ◽  
Medical Schools ◽  
First Year ◽  
Structured Interviews ◽  
Individual Interviews ◽  
Group Interviews ◽  
The Uk ◽  
First Year Medical Students

BackgroundThe NHS is critically short of doctors. The sustainability of the UK medical workforce depends on medical schools producing more future GPs who are able and willing to care for under-served patient populations. The evidence for how medical schools should achieve this is scarce. We know medical schools vary in how they attract, select, and educate future doctors. We know some medical schools produce more GPs, but it is uncertain whether those school recruit more students who are interested in general practice.AimThis study seeks to explore how applicants’ future speciality ambitions influence their choice of medical school.MethodOne-to-one semi-structured interviews and focus groups were conducted with medical applicants and first year medical students at eight medical schools around the UK. Interviews were audiorecorded and transcribed verbatim. Transcripts were analysed through thematic analysis by one researcher. A sample of 20% of transcripts were analysed by a second researcher.ResultsSixty-six individuals participated in 61 individual interviews and one focus group. Interviews lasted a mean of 54 minutes (range 22–113). Twelve expressed interest in general practice, 40 favoured other specialities, and 14 were unsure. Participants’ priorities varied by speciality aspiration; those interested in general practice described favouring medical schools with early clinical experience and problem-based learning curricula, and were less concerned with cadaveric dissection and the prestige of the medical school.ConclusionMany applicants consider future speciality ambitions before applying to medical school. Speciality aspiration appears to influence priority of medical schools’ attributes.

scholarly journals Analysis of Seaweeds from South West England as a Biorefinery Feedstock

2019 ◽  
Vol 9 (20) ◽  
pp. 4456 ◽  
Author(s):  
Tracey A. Beacham ◽  
Isobel S. Cole ◽  
Louisa S. DeDross ◽  
Sofia Raikova ◽  
Christopher J. Chuck ◽  
...  
Keyword(s):  
West Coast ◽  
Food Industry ◽  
Single Product ◽  
Commercial Exploitation ◽  
Multiple Products ◽  
Multiple Components ◽  
South West ◽  
South West Coast ◽  
The Uk ◽  
South West England

Seaweeds contain many varied and commercially valuable components, from individual pigments and metabolites through to whole biomass, and yet they remain an under cultivated and underutilised commodity. Currently, commercial exploitation of seaweeds is predominantly limited to whole biomass consumption or single product extracts for the food industry. The development of a seaweed biorefinery, based around multiple products and services, could provide an important opportunity to exploit new and currently underexplored markets. Here, we assessed the native and invasive seaweeds on the South West coast of the UK to determine their characteristics and potential for exploitation through a biorefinery pipeline, looking at multiple components including pigments, carbohydrates, lipids, proteins and other metabolites.

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