Dale Jeremy, Potter Rachel, Owen Katherine, Parsons Nicholas, Realpe Alba, Leach Jonathan
Warwick Medical School, Coventry, CV4 7AL, UK.
Davenal House Surgery, Bromsgrove, Worcestershire, B61 0DD, UK.
BMC Fam Pract. 2015 Oct 16;16:140. doi: 10.1186/s12875-015-0363-1.
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.
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.
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.
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.
英格兰的全科医生（GP）队伍正处于危机之中，这体现在提前退休率上升以及减少工作时长的意愿上。本研究旨在调查潜在因素以及如何缓解这些因素。
邀请英格兰中部的全科医生参与一项在线调查，探讨职业规划以及对工作相关压力的看法和经历。定量数据采用逻辑回归分析和主成分分析进行分析。定性数据采用主题框架法进行分析。
在参与调查的1192名全科医生中，978名（82.0%）表示他们打算在未来五年内离开全科医疗、休假一段时间和/或减少临床工作时长。这其中包括488名（41.9%）打算离开全科医疗的医生，以及近四分之一（279名；23.2%）打算休假的医生。只有67名（5.6%）计划增加他们的临床工作时长。对于打算离开全科医疗的参与者来说，最影响其意愿的问题是工作量的大小和强度、花在“不重要任务”上的时间、引入七天工作制以及工作满意度低。455名参与者回答了开放性问题（总共39128个单词）。主要主题是工作相关压力的累积影响、工作量不断变化和增加的性质以及随之而来的压力。减少工作量强度、工作量大小、行政活动，增加患者护理时间，无非工作时间任务，更灵活的工作条件以及更大的临床自主权被确定为解决劳动力危机最重要的要求。此外，激励性报酬、加薪以及受保护的教育和培训时间也被认为很重要。
可能需要新的职业精神和组织安排模式来解决这里所描述的问题。如果不采取紧急行动，英格兰的全科医生劳动力危机似乎将恶化。
