Appleton K, House A, Dowell A
Academic Unit of Child and Adolescent Mental Health, Leeds University.
Br J Gen Pract. 1998 Mar;48(428):1059-63.
The past seven years have seen rapid changes in general practice in the United Kingdom (UK), commencing with the 1990 contract. During the same period, concern about the health and morale of general practitioners (GPs) has increased and a recruitment crisis has developed.
To determine levels of psychological symptoms, job satisfaction, and subjective ill health in GPs and their relationship to practice characteristics, and to compare levels of job satisfaction since the introduction of the 1990 GP contract with those found before 1990.
Postal questionnaire survey of all GP principals on the Leeds Health Authority list. The main outcome measures included quantitative measures of practice characteristics, job satisfaction, mental health (General Health Questionnaire), and general physical health. Qualitative statements about work conditions, job satisfaction, and mental health were collected.
A total of 285/406 GPs (70%) returned the questionnaires. One hundred and forty-eight (52%) scored 3 or more on the General Health Questionnaire (GHQ-12), which indicates a high level of psychological symptoms. One hundred and sixty GPs (56%) felt that work had affected their recent physical health. Significant associations were found between GHQ-12 scores, total job satisfaction scores, and GPs' perceptions that work had affected their physical health. Problems with physical and mental health were associated with several aspects of workload, including list size, number of sessions worked per week, amount of time spent on call, and use of deputizing services. In the qualitative part of the survey, GPs reported overwork and excessive hours, paperwork and administration, recent National Health Service (NHS) changes, and the 1990 GP contract as the most stressful aspects of their work.
Fifty-two per cent of GPs in Leeds who responded showed high levels of psychological symptoms. Job satisfaction was lower than in a national survey conducted in 1987, and GPs expressed the least satisfaction with their hours, recognition for their work, and rates of pay. Nearly 60% felt that their physical health had been affected by their work. These results point to a need to improve working conditions in primary care and for further research to determine the effect of any such changes.
自1990年合同签订以来，英国的全科医疗在过去七年中发生了迅速变化。在此期间，对全科医生（GP）健康状况和士气的担忧增加，并且出现了招聘危机。
确定全科医生的心理症状水平、工作满意度和主观健康状况，以及它们与执业特征的关系，并比较1990年全科医生合同引入后与1990年之前的工作满意度水平。
对利兹卫生局名单上的所有全科医生负责人进行邮政问卷调查。主要结果指标包括执业特征、工作满意度、心理健康（一般健康问卷）和总体身体健康的量化指标。收集了关于工作条件、工作满意度和心理健康的定性陈述。
共有285/406名全科医生（70%）回复了问卷。148名（52%）在一般健康问卷（GHQ - 12）上得分3分或更高，这表明心理症状水平较高。160名全科医生（56%）认为工作影响了他们近期的身体健康。在GHQ - 12得分、总体工作满意度得分与全科医生认为工作影响其身体健康的看法之间发现了显著关联。身心健康问题与工作量的几个方面相关，包括患者名单规模、每周工作时段数、值班时间以及使用代理服务情况。在调查的定性部分，全科医生报告工作过度和工作时间过长、文书工作和行政管理、近期国民健康服务（NHS）的变化以及1990年全科医生合同是他们工作中压力最大的方面。
回复问卷的利兹全科医生中有52%表现出高水平的心理症状。工作满意度低于1987年进行的全国性调查，全科医生对工作时间、工作认可度和薪酬的满意度最低。近60%的人认为他们的身体健康受到了工作的影响。这些结果表明需要改善基层医疗的工作条件，并进行进一步研究以确定任何此类变化的影响。
