Lost to the NHS: a mixed methods study of why GPs leave practice early in England
Lost to the NHS: a mixed methods study of why GPs leave practice early in England
复制标题
DOI：
10.3399/bjgp16x683425
复制
发表时间：
2016-02-01
影响因子：
5.9
通讯作者：
Harris, Michael
中科院分区：
文献类型：
--
作者：
Doran, Natasha;Fox, Fiona;Harris, Michael
背景全科医生在职业生涯早期的流失导致了全科医生劳动力危机。英国的招聘人数仍然低于支持全科医生护理需求所需的人数。目的是探讨全科医生提前离开全科诊所的原因。设计和设置使用在线调查数据与定性访谈进行三角测量的混合方法研究。方法参与者是年龄<50岁的全科医生，他们在过去5年（2009-2014年）中离开了英国医疗表演者名单。共有 143 名早期全科医生离职者参与了在线调查，其中 21 人参加了电话录音采访。调查数据采用描述性统计分析，定性数据采用专题分析技术进行分析。结果离职原因是累积性的、多因素的。 NHS 的组织变革导致行政任务和总体工作量增加，全科医生参与者认为这从根本上改变了医患关系。缺乏与患者相处的时间损害了全科医生实施以患者为中心的护理的能力，进而影响了全科医生的职业自主权和价值观，导致工作满意度下降。在这种情况下，患者需求增加和媒体负面报道带来的额外压力让许多人感到不受支持，容易出现倦怠和健康状况不佳，并最终决定离开全科诊所。结论为了提高年轻全科医生的保留率，需要最大限度地减少行政变革的步伐，并减少全科医生花在非面对面患者护理工作上的时间。
BackgroundThe loss of GPs in the early stages of their careers is contributing to the GP workforce crisis. Recruitment in the UK remains below the numbers needed to support the demand for GP care.AimTo explore the reasons why GPs leave general practice early.Design and settingA mixed methods study using online survey data triangulated with qualitative interviews.MethodParticipants were GPs aged < 50 years who had left the English Medical Performers List in the last 5 years (2009-2014). A total of 143 early GP leavers participated in an online survey, of which 21 took part in recorded telephone interviews. Survey data were analysed using descriptive statistics, and qualitative data using thematic analysis techniques.ResultsReasons for leaving were cumulative and multifactorial. Organisational changes to the NHS have led to an increase in administrative tasks and overall workload that is perceived by GP participants to have fundamentally changed the doctor-patient relationship. Lack of time with patients has compromised the ability to practise more patient-centred care, and, with it, GPs' sense of professional autonomy and values, resulting in diminished job satisfaction. In this context, the additional pressures of increased patient demand and the negative media portrayal left many feeling unsupported and vulnerable to burnout and ill health, and, ultimately, to the decision to leave general practice.ConclusionTo improve retention of young GPs, the pace of administrative change needs to be minimised and the time spent by GPs on work that is not face-to-face patient care reduced.