Understanding complex issues of GP retention using a visual model to interface qualitative evidence synthesis, patient involvement and primary research




Poster session 1 Wednesday: Evidence production and synthesis


Wednesday 13 September 2017 - 12:30 to 14:00


All authors in correct order:

Long L1, Sansom A2, Terry R3, Aylward A4, Welsman J5, Fletcher E2, Campbell J2, Dean S6
1 Evidence Synthesis & Modelling for Health Improvement (ESMI),University of Exeter Medical School, United Kingdom
2 Primary Care Research Group, University of Exeter Medical School, United Kingdom
3 School of Social and Community Medicine, University of Bristol, United Kingdom
4 Patient Representative, University of Exeter Medical School, United Kingdom
5 Centre for Biomedical Modelling and Analysis, University of Exeter, United Kingdom
6 Psychology Applied to Health, University of Exeter Medical School, United Kingdom
Presenting author and contact person

Presenting author:

Linda Long

Contact person:

Abstract text
Background: Many UK GPs are leaving, or intending to leave, general practice. Our research is part of a wider mixed-methods study (ReGROUP) focusing on retention of the experienced GP workforce.

Objectives: To identify factors that affect GPs’ decisions to quit direct patient care, take career breaks from general practice, and return to general practice after a career break.

Methods: We undertook a systematic review of qualitative research to identify factors that affect GP retention. Five UK interview-based studies were found and quality assessed using the adapted 'Wallace tool'. A thematic synthesis was performed using NVivo software and a graphic 'explanatory model' constructed to provide an overview of the key contexts and factors. The model was presented in two discussion groups with patient representatives and primary qualitative researchers from the wider team.

Results: A detailed explanatory framework of factors which underlie GPs satisfaction/dissatisfaction in their role emerged from the evidence. Verification of the model’s applicability was confirmed by both patient representatives and primary research co-investigators. Three central dynamics key to understanding UK GP quitting behaviour emerged in the graphic model – factors associated with low job satisfaction, high job satisfaction, and those linked to the doctor-patient relationship – set within the contextual influence of the changing nature of clinical practice. Patient representatives noted that factors contributing to high job satisfaction were under-represented in the model, resulting in primary researchers adjusting their sampling frame to capture the experiences of GPs intending to remain in general practice.

Conclusions:A visual explanatory model was used to facilitate discussion with both patient representatives and primary researchers to check 'real life' applicability of review findings and 'join up' different elements of the wider ReGROUP research programme. The model highlighted gaps in current understanding and primary researchers responded to ensure elicitation of views from 'remaining' GPs.