GPs’ perceptions of workload in England: a qualitative interview study

BackgroundGPs 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.AimTo gather an in-depth understanding of GPs’ perceptions and attitudes towards workload.Design and settingAll 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.MethodSemi-structured, qualitative interviews were conducted. Data were analysed thematically.ResultsIn 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.ConclusionThis 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.

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GP views on strategies to cope with increasing workload: a qualitative interview study

British Journal of General Practice ◽

10.3399/bjgp17x688861 ◽

2017 ◽

Vol 67 (655) ◽

pp. e148-e156 ◽

Cited By ~ 27

Author(s):

Rebecca FR Fisher ◽

Caroline HD Croxson ◽

Helen F Ashdown ◽

FD Richard Hobbs

Keyword(s):

Primary Care ◽

Healthcare Professionals ◽

Qualitative Interviews ◽

Self Management ◽

Telephone Triage ◽

Workload Management ◽

Qualitative Interview Study ◽

Data Saturation ◽

The Uk ◽

Maximum Variation Sample

BackgroundThe 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.AimTo explore what existing or potential strategies are described by GPs for dealing with their workload, and their views on the relative merits of each.Design and settingSemi-structured, qualitative interviews with GPs working within NHS England.MethodAll 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.ResultsResponses 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.ConclusionThis 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.

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Chlamydia and HIV testing, contraception advice, and free condoms offered in general practice: a qualitative interview study of young adults’ perceptions of this initiative

British Journal of General Practice ◽

10.3399/bjgp17x691325 ◽

2017 ◽

Vol 67 (660) ◽

pp. e490-e500 ◽

Cited By ~ 2

Author(s):

Leah Ffion Jones ◽

Ellie Ricketts ◽

Katy Town ◽

Claire Rugman ◽

Donna Lecky ◽

...

Keyword(s):

General Practice ◽

Young Adults ◽

Sexual Health ◽

Hiv Testing ◽

Service Providers ◽

Qualitative Interviews ◽

Chlamydia Screening ◽

Routine Practice ◽

National Guidelines ◽

Qualitative Interview Study

BackgroundOpportunistic chlamydia screening is actively encouraged in English general practices. Based on recent policy changes, Public Health England piloted 3Cs and HIV in 2013–2014, integrating the offer of chlamydia testing with providing condoms, contraceptive information, and HIV testing (referred to as 3Cs and HIV) according to national guidelines.AimTo determine young adults’ opinions of receiving a broader sexual health offer of 3Cs and HIV at their GP practice.Design and settingQualitative interviews were conducted in a general practice setting in England between March and June 2013.MethodThirty interviews were conducted with nine male and 21 female patients aged 16–24 years, immediately before or after a routine practice attendance. Data were transcribed verbatim and analysed using a thematic framework.ResultsParticipants indicated that the method of testing, timing, and the way the staff member approached the topic were important aspects to patients being offered 3Cs and HIV. Participants displayed a clear preference for 3Cs and HIV to be offered at the GP practice over other sexual health service providers. Participants highlighted convenience of the practice, assurance of confidentiality, and that the sexual health discussion was appropriate and routine. Barriers identified for patients were embarrassment, unease, lack of time, religion, and patients believing that certain patients could take offence. Suggested facilitators include raising awareness, reassuring confidentiality, and ensuring the offer is made in a professional and non-judgemental way at the end of the consultation.ConclusionGeneral practice staff should facilitate patients’ preferences by ensuring that 3Cs and HIV testing services are made available at their surgery and offered to appropriate patients in a non-judgemental way.

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Vision-related quality of life in adults with severe peripheral vision loss: a qualitative interview study

Journal of Patient-Reported Outcomes ◽

10.1186/s41687-020-00281-y ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Ryan Lange ◽

Abigail Kumagai ◽

Sara Weiss ◽

Katherine B. Zaffke ◽

Sherry Day ◽

...

Keyword(s):

Quality Of Life ◽

Contrast Sensitivity ◽

Qualitative Interviews ◽

Well Being ◽

Vision Impairment ◽

Qualitative Interview Study ◽

Patient Reported ◽

Related Quality ◽

The Impact

Abstract Background Existing patient-reported outcome (PRO) measures may not be relevant to the full range of functional and vision-related quality of life (VR-QOL) concerns of individuals with vision impairment due to severe peripheral field loss (PFL). Measurement of VR-QOL in severe PFL is important in order to determine the effectiveness of vision rehabilitation interventions for this population. The purpose of this study was to characterize the impact of severe PFL due to retinitis pigmentosa (RP) and glaucoma on VR-QOL as the initial phase in the development of a novel PRO measure. Methods Individuals with severe PFL due to RP or glaucoma were recruited from the Kellogg Eye Center and the Association for the Blind and Visually Impaired. Participants completed semi-structured qualitative interviews, the Impact of Vision Impairment (IVI) questionnaire and the RAND 36-Item Health Survey. Interviews were analyzed by two coders using thematic analysis. A matrix analysis was conducted to compare VR-QOL by cause of severe PFL. Sample size was determined by thematic saturation. Results The study included 37 participants (19 RP, 18 glaucoma). Median best-corrected visual acuity for those with RP and glaucoma was 20/40 and 20/27.5, while Pelli-Robson contrast sensitivity was 1.2 log contrast sensitivity (logCS) and 1.1 logCS, respectively. Median domain scores on the IVI (reading, mobility, well-being) ranged from a low of − 0.2 to a high of 0.7 logits in those with RP and from 0.5 to 1.2 logits in those with glaucoma. Qualitative interviews identified six VR-QOL themes relevant across participants with both RP and glaucoma, including activity limitations, driving, emotional well-being, reading, mobility, and social function. VR-QOL concerns were largely consistent among those with severe PFL due to RP and glaucoma. These overarching themes contained content relevant to specific challenges related to severe PFL. Conclusions There are commonly occurring VR-QOL concerns among individuals with severe PFL due to RP and glaucoma. The outlined themes will serve as the basis for development of the Low Vision Severely Constricted Peripheral Eyesight (LV-SCOPE) Questionnaire.

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Men’s experiences of radiotherapy treatment for localized prostate cancer and its long-term treatment side effects: a longitudinal qualitative study

Cancer Causes & Control ◽

10.1007/s10552-020-01380-3 ◽

2021 ◽

Author(s):

E. Sutton ◽

◽

J. A. Lane ◽

M. Davis ◽

E. I. Walsh ◽

...

Keyword(s):

Prostate Cancer ◽

Side Effects ◽

External Beam Radiotherapy ◽

Qualitative Interviews ◽

Well Being ◽

Localized Prostate Cancer ◽

Short Term ◽

Age Related ◽

Qualitative Interview Study ◽

Long Term Treatment

Abstract Purpose To investigate men’s experiences of receiving external-beam radiotherapy (EBRT) with neoadjuvant Androgen Deprivation Therapy (ADT) for localized prostate cancer (LPCa) in the ProtecT trial. Methods A longitudinal qualitative interview study was embedded in the ProtecT RCT. Sixteen men with clinically LPCa who underwent EBRT in ProtecT were purposively sampled to include a range of socio-demographic and clinical characteristics. They participated in serial in-depth qualitative interviews for up to 8 years post-treatment, exploring experiences of treatment and its side effects over time. Results Men experienced bowel, sexual, and urinary side effects, mostly in the short term but some persisted and were bothersome. Most men downplayed the impacts, voicing expectations of age-related decline, and normalizing these changes. There was some reticence to seek help, with men prioritizing their relationships and overall health and well-being over returning to pretreatment levels of function. Some unmet needs with regard to information about treatment schedules and side effects were reported, particularly among men with continuing functional symptoms. Conclusions These findings reinforce the importance of providing universal clear, concise, and timely information and supportive resources in the short term, and more targeted and detailed information and care in the longer term to maintain and improve treatment experiences for men undergoing EBRT.

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Improving the Quality of Children’s Mental Health Care with Progress Measures: A Mixed-Methods Study of PCIT Therapist Attitudes

Administration and Policy in Mental Health and Mental Health Services Research ◽

10.1007/s10488-021-01156-0 ◽

2021 ◽

Author(s):

Corinna C. Klein ◽

B. Erika Luis Sanchez ◽

Miya L. Barnett

Keyword(s):

Mental Health ◽

Health Care ◽

General Practice ◽

Qualitative Interviews ◽

Behavioral Observation ◽

Parent Report ◽

Therapist Attitudes ◽

Child Interaction ◽

Report Measure

AbstractProgress measures are an evidence-based technique for improving the quality of mental health care, however, clinicians rarely incorporate them into treatment. Research into how measure type impacts clinician preference has been recommended to help improve measure implementation. Parent–Child Interaction Therapy (PCIT) is an assessment-driven treatment that serves as an ideal intervention through which to investigate measure preferences given its routine use of two types of assessments, a behavioral observation (the Dyadic Parent–Child Interaction Coding System) and a parent-report measure (the Eyberg Child Behavior Inventory). This study investigated PCIT therapist attitudes towards progress measures used within PCIT and children’s mental health treatment generally. A mixed-method (QUAN + QUAL) study design examined PCIT therapist attitudes towards two types of progress measures and measures used in two contexts (PCIT and general practice). Multi-level modeling of a survey distributed to 324 PCIT therapists identified predictors of therapist attitudes towards measures, while qualitative interviews with 23 therapists expanded and clarified the rationale for differing perceptions. PCIT therapists reported more positive attitudes towards a behavioral observation measure, the DPICS, than a parent-report measure, the ECBI, and towards measures used in PCIT than in general practice. Clinician race/ethnicity was significantly related to measure-specific attitudes. Qualitative interviews highlighted how perceptions of measure reliability, type of data offered, ease of use, utility in guiding sessions and motivating clients, and embeddedness in treatment protocol impact therapist preferences. Efforts to implement progress monitoring should consider preferences for particular types of measures, as well as how therapists are trained to embed measures in treatment.

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Mental Health Research in General Practice

Australasian Psychiatry ◽

10.1080/j.1440-1665.2005.02185.x ◽

2005 ◽

Vol 13 (2) ◽

pp. 181-184 ◽

Cited By ~ 6

Author(s):

Harry Minas ◽

Steven Klimidis ◽

Renata Kokanovic

Keyword(s):

Mental Health ◽

General Practice ◽

General Practitioners ◽

Health Research ◽

Mental Health Research ◽

Practice Research ◽

Practice Setting ◽

Key Issues ◽

Practice Time ◽

Time Limitations

Objective: To explore problems in carrying out a mental health research project in the general practice setting. Method: Open-ended interviews were conducted with general practice stakeholders, focusing on impediments to the conduct of mental health research in general practice and possible means for improving the participation of general practitioners in such research. Participants in the consultations were members of ?ve divisions of general practice, senior staff within an academic department of general practice, four general practitioners and a research group engaged with general practice research. The discussions were recorded in detailed interview notes, and key issues and themes emerging from consultations were derived by the researchers. Results: Three main themes summarized most of the issues reported through the consultations, including structural issues (e.g. disruption of practice, time limitations and lack of remuneration), process issues (e.g. researcher–general practice communication, researcher-imposed issues and need for partnerships) and content issues (e.g. study design, study procedures and methods). Conclusions: The consultations revealed similar ?ndings to previously published reports concerning general practice research, with an emphasis on the need for partnerships between researchers and general practice organizations in the conduct of such research.

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Barriers to a software reminder system for risk assessment of stroke in atrial fibrillation: a process evaluation of a cluster randomised trial in general practice

British Journal of General Practice ◽

10.3399/bjgp18x699809 ◽

2018 ◽

Vol 68 (677) ◽

pp. e844-e851

Author(s):

Tim A Holt ◽

Andrew RH Dalton ◽

Susan Kirkpatrick ◽

Jenny Hislop ◽

Tom Marshall ◽

...

Keyword(s):

Atrial Fibrillation ◽

Risk Assessment ◽

General Practice ◽

Process Evaluation ◽

Oral Anticoagulants ◽

Qualitative Interviews ◽

Randomised Trial ◽

Software Tool ◽

Cluster Randomised Trial ◽

Cluster Randomised

BackgroundOral anticoagulants reduce the risk of stroke in patients with atrial fibrillation (AF), but are underused. AURAS-AF (AUtomated Risk Assessment for Stroke in AF) is a software tool designed to identify eligible patients and promote discussions within consultations about initiating anticoagulants.AimTo investigate the implementation of the software in UK general practice.Design and settingProcess evaluation involving 23 practices randomly allocated to use AURAS-AF during a cluster randomised trial.MethodAn initial invitation to discuss anticoagulation was followed by screen reminders appearing during consultations until a decision had been made. The reminders required responses, giving reasons for cases where an anticoagulant was not initiated. Qualitative interviews with clinicians and patients explored acceptability and usability.ResultsIn a sample of 476 patients eligible for the invitation letter, only 159 (33.4%) were considered suitable for invitation by their GPs. Reasons given were frequently based on frailty, and risk of falls or haemorrhage. Of those invited, 35 (22%) started an anticoagulant (7.4% of those originally identified). A total of 1695 main-screen reminders occurred in 940 patients. In 883 instances, the decision was taken not to initiate and a range of reasons offered. Interviews with 15 patients and seven clinicians indicated that the intervention was acceptable, though the issue of disruptive screen reminders was raised.ConclusionAutomated risk assessment for stroke in atrial fibrillation and prompting during consultations are feasible and generally acceptable, but did not overcome concerns about frailty and risk of haemorrhage as barriers to anticoagulant uptake.

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Experiences of living with mental health problems during the COVID-19 pandemic in the UK: a coproduced, participatory qualitative interview study

10.1101/2020.11.03.20225169 ◽

2020 ◽

Author(s):

Steven Gillard ◽

Ceri Dare ◽

Jackie Hardy ◽

Patrick Nyikavaranda ◽

Rachel Rowan Olive ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Social Connectedness ◽

Mental Health Problems ◽

Qualitative Interviews ◽

Health Conditions ◽

Mental Health Conditions ◽

Qualitative Interview Study ◽

The Impact

AbstractPurposeResearch is beginning to quantify the impact of COVID-19 on people with pre-existing mental health conditions. Our paper addresses a lack of in-depth qualitative research exploring their experiences and perceptions of how life has changed at this time.MethodsWe used qualitative interviews (N=49) to explore experiences of the pandemic for people with pre-existing mental health conditions. In a participatory, coproduced approach, researchers with lived experiences of mental health conditions conducted interviews and analysed data as part of a multi-disciplinary research team.ResultsExisting mental health difficulties were exacerbated for many people. People experienced specific psychological impacts of the pandemic, struggles with social connectedness, and inadequate access to mental health services, while some found new ways to cope and connect to community. New remote ways to access mental health care, including digital solutions, provided continuity of care for some but presented substantial barriers for others. People from black and ethnic minority (BAME) communities experienced heightened anxiety, stigma and racism associated with the pandemic, further impacting their mental health.ConclusionThere is a need for evidence-based solutions to achieve accessible and effective mental health care in response to the pandemic, especially remote approaches to care. Further research should explore the long-term impacts of COVID-19 on people with pre-existing mental health conditions. Particular attention should be paid to understanding inequalities of impact on mental health, especially for people from BAME communities.

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Understanding the benefits and limitations of continuous, risk-based, consultation peer-review in out-of-hours general practice: A qualitative interview study

British Journal of General Practice ◽

10.3399/bjgp.2021.0076 ◽

2021 ◽

pp. BJGP.2021.0076

Author(s):

Ian Bennett-Britton ◽

Jonathan Banks ◽

Andrew Carson-Stevens ◽

Chris Salisbury

Keyword(s):

General Practice ◽

Peer Review ◽

Qualitative Interview ◽

Interview Study ◽

Learning Culture ◽

Learning Needs ◽

Full Potential ◽

Programme Theory ◽

Out Of Hours ◽

Qualitative Interview Study

Background: Systems to detect and minimise unwarranted variation in clinician practice are crucial to ensure increasingly multidisciplinary healthcare workforces are supported to practice to their full potential. Such systems are limited in English general practice settings, with implications for the efficiency and safety of care. Aim: To evaluate the benefits and limitations of a continuous, risk-based, consultation peer-review system used for 10 years by an out-of-hours general practice service in Bristol, UK. Design and setting: A qualitative interview study in South-West England. Method: Semi-structured interviews with intervention users (clinicians, peer-reviewers and clinical management), analysed by inductive thematic analysis and integrated into a programme theory. Results: 20 clinicians were interviewed between September 2018 - January 2019. Interviewees indicated the intervention supported clinician learning through improved peer-feedback; highlighting learning needs and validating practice. It was compared favourably with existing structures of ensuring clinician competence; supporting standardisation of supervision, clinical governance and learning culture. These benefits were potentially limited by intervention factors such as differential feedback quality between clinician groups, the efficiency of methods to identify learning needs, and limitations of assessments based on written clinical notes. Contextual factors such as clinician experience, motivation and organisational learning culture influenced the perception of the intervention as a support or stressor. Conclusion: Our findings demonstrate the potential of this methodology to support clinicians in an increasingly multidisciplinary general practice workforce to efficiently and safely practice to their full potential. Our programme theory provides a theoretical basis to maximise its benefits and accommodate its potential limitations.

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Knowledge and perspectives of the new National Cervical Screening Program: a qualitative interview study of North Queensland women—‘I could be that one percent’

BMJ Open ◽

10.1136/bmjopen-2019-034483 ◽

2020 ◽

Vol 10 (3) ◽

pp. e034483 ◽

Cited By ~ 1

Author(s):

Archana Nagendiram ◽

Rachel Bidgood ◽

Jennifer Banks ◽

Clare Heal

Keyword(s):

General Practice ◽

Screening Program ◽

Cervical Screening ◽

Personal Factors ◽

Snowball Sampling ◽

Additional Information ◽

Screening Participation ◽

Increased Risk ◽

Qualitative Interview Study ◽

And Gender

ObjectivesTo investigate women’s understanding and attitudes towards the National Cervical Screening Program (NCSP) and to explore methods to improve screening participation.DesignSemi-structured face-to-face interviews were conducted through convenience and snowball sampling. Thematic analysis occurred using the interpretivist framework.SettingA private general practice in North Queensland.ParticipantsWomen between the ages of 18 and 74 who attended the general practice were eligible to participate. Fourteen women between 20 and 58 years old were interviewed.ResultsParticipants were concerned that the new NCSP would miss cancer due to longer screening intervals and reliance on primary human papilloma virus (HPV) testing. They believed that young women are at increased risk of cervical cancer, due to perceived HPV vaccine ineffectiveness and parent objection to vaccination. Most participants were not agreeable to self-sampling and preferred their doctor to perform screening. Personal and practitioner beliefs influenced a woman’s screening participation. Personal factors include being healthy for themselves and their family, previous abnormal smears and family history of cancer. Emphasis was placed on feeling ‘comfortable’ with their practitioner which included patient rapport and gender preference. Proposed methods to improve cervical screening included education programmes, advertising campaigns, general practitioner interventions and improving accessibility.ConclusionsIt is apparent that women are hesitant about the new NCSP. However, when provided with additional information they were more amenable to the changes. This highlights the need to improve awareness of cervical screening and the new NCSP.

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