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英国全科医生的保留问题:日益恶化的危机。一项横断面调查的结果。

GP retention in the UK: a worsening crisis. Findings from a cross-sectional survey.

机构信息

Division of Health Sciences, Warwick Medical School, Coventry, UK.

出版信息

BMJ Open. 2019 Feb 27;9(2):e026048. doi: 10.1136/bmjopen-2018-026048.

Abstract

OBJECTIVE

To investigate how recent national policy-led workforce interventions are affecting intentions to remain working as a general practitioner (GP).

DESIGN

Online questionnaire survey with qualitative and quantitative questions.

SETTING AND PARTICIPANTS

All GPs (1697) in Wessex region, an area in England for which previous GP career intention data from 2014 is available.

RESULTS

929 (54.7%) participated. 59.4% reported that morale had reduced over the past two years, and 48.5% said they had brought forward their plans to leave general practice. Intention to leave/retire in the next 2 years increased from 13% in the 2014 survey to 18% in October/November 2017 (p=0.02), while intention to continue working for at least the next 5 years dropped from 63.9% to 48.5% (p<0.0001). Age, length of service and lower job satisfaction were associated with intention to leave. Work intensity and amount were the most common reasons given for intention to leave sooner than previously planned; 51.0% participants reported working more hours than 2 years previously, predominantly due to increased workload.GPs suggested increased funding, more GPs, better education of the public and expanding non-clinical and support staff as interventions to improve GP retention.National initiatives that aligned with these priorities, such as funding to expand practice nursing were viewed positively, but low numbers of GPs had seen evidence of their roll-out. Conversely, national initiatives that did not align, such as video consulting, were viewed negatively.

CONCLUSION

While recent initiatives may be having an impact on targeted areas, most GPs are experiencing little effect. This may be contributing to further lowering of morale and bringing forward intentions to leave. More urgent action appears to be needed to stem the growing workforce crisis.

摘要

目的

调查近期国家政策主导的劳动力干预措施对全科医生(GP)继续从业意愿的影响。

设计

带有定性和定量问题的在线问卷调查。

地点和参与者

英格兰西南部地区的所有全科医生(1697 名),该地区之前有 2014 年全科医生职业意向数据。

结果

929 名(54.7%)参与了调查。59.4%的人报告说,过去两年士气有所下降,48.5%的人表示他们提前计划离开全科医学。未来 2 年内离开/退休的意向从 2014 年调查的 13%增加到 2017 年 10/11 月的 18%(p=0.02),而至少未来 5 年内继续工作的意向从 63.9%降至 48.5%(p<0.0001)。年龄、服务年限和较低的工作满意度与离职意向相关。工作强度和工作量是提前离职的最常见原因;51.0%的参与者报告说,他们现在的工作时间比两年前多,主要是因为工作量增加。GP 建议增加资金、增加更多的全科医生、更好地教育公众、扩大非临床和支持人员,作为提高 GP 留任率的干预措施。与这些优先事项一致的国家举措,如扩大执业护士的资金,受到了积极的评价,但很少有 GP 看到了这些举措的实施。相反,不符合这些优先事项的国家举措,如视频咨询,则受到了负面评价。

结论

虽然最近的举措可能对特定领域产生了影响,但大多数全科医生几乎没有感受到影响。这可能进一步降低了士气,提前了离职的意愿。似乎需要采取更紧急的行动来遏制日益严重的劳动力危机。

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