British Journal of General Practice最新文献

Background: The challenges of recruiting and retaining rural GPs are well described. UK data suggest high levels of burnout, characterised by detachment, exhaustion, and cynicism, plays a role in GP turnover. The contrast is engagement with work. There is limited evidence examining the relationship between work engagement and recruitment and retention in rural areas.

Aim: To qualitatively investigate GPs decisions to move or stay in rural areas through exploring areas that can promote work engagement.

Design and setting: This was a secondary analysis of qualitative data with Scottish GPs.

Method: A secondary analysis of 44 semi-structured interviews with GPs from across Scotland was undertaken. Data were analysed thematically and the Areas of Worklife Scale was used to structure data.

Results: Factors associated with burnout were identified and experienced as barriers to moving or staying rurally. Fear of dealing with pre-hospital emergency cases, clinical isolation, and rural training were concerns. Personal factors such as lack of partner employment played a key role in migration decisions. Factors associated with engagement were identified and experienced as facilitators for moving or staying rurally. Professional networks reduced professional isolation and rural GPs valued increased autonomy and time. Many felt being a rural GP was more aligned with their professional values and highly valued the rural lifestyle for themselves and their families.

Conclusion: Our data suggest that factors associated with engagement and burnout can contribute to rural GPs' migration decisions. We highlight four areas that could promote desirable work environments by mitigating burnout and promoting engagement at work.

Background: The Additional Roles Reimbursement Scheme (ARRS) was introduced in England in 2019 to alleviate workforce pressures in general practice by funding additional staff such as clinical pharmacists, paramedics, first-contact physiotherapists, and from 1 October 2024 the scheme funds recently qualified GPs. However, the employment and deployment models of ARRS staff present ongoing complexities and challenges that require further exploration.

Aim: To explore the decision-making processes behind primary care networks (PCNs) and general practice staffing choices, and how these choices influence the operationalisation of ARRS.

Design and setting: This was a qualitative case study across four PCNs in England using a realist evaluation framework.

Method: Data collection took place between September 2022 and November 2023. Semi-structured interviews were conducted with PCN clinical directors, GPs, practice managers, and ARRS staff (n = 42). Transcripts were analysed using a realist evaluation framework to identify the context-mechanism-outcome configurations.

Results: Direct employment models fostered staff development and retention, contingent on established trust among practices. Subcontracting was favoured to mitigate employment risks but could lead to unintended consequences such as conflicting accountabilities and less integration with existing GP practice staff. The optimal deployment model involved rotations across a limited number of GP practices, ideally two, with one serving as a base, ensuring consistency in training and management.

Conclusion: This study provides novel insights into the complexities of different employment and deployment models of ARRS staff. These findings will be invaluable for creating a sustainable GP practice workforce and informing future workforce strategies as the scheme expands to include recently qualified GPs.

Background: General practice faces pressures because of increased demand and a shortage of GPs. Paramedics in general practice (PGPs) increasingly contribute to managing minor illnesses, conducting home visits, and providing urgent consultations.

Aim: To explore the impact of paramedic consultations on patient-reported experience, safe management, and NHS costs.

Design and setting: Prospective cohort study comparing PGP with GP consultations at 34 GP sites in England.

Method: Eligible participants had a consultation with a PGP (25 PGP sites) or GP (nine non-PGP sites) between May 2022 and February 2023. Questionnaires were provided after the initial consultation and 30 days later. Questionnaires assessed patient experience, outcomes, and perceived safety (PCOQ and PREOS PC), quality of life (EQ-5D-5L), and healthcare use.

Results: Of 715 participants recruited, 489 completed the 30-day questionnaire. No evidence was found that PGP consultations resulted in greater improvement/deterioration in patient-reported health and wellbeing (-0.03, 95% confidence interval [CI] = -0.09 to 0.04); confidence in health provision (-0.05, 95% CI = -0.15 to 0.05); health knowledge (0.05, 95% CI = -0.04 to 0.15); or confidence in the health plan (-0.06, 95% CI = -0.11 to -0.01) over the 30-day period. However, the PGP group reported lower confidence in health provision (mean 4.0 versus 4.5; P<0.001), poorer perceptions of practice engagement in safety promotion (median 75 versus 88; P<0.001), and more communication problems with staff (17% versus 8%; P<0.001) immediately after the initial consultation. Patients receiving PGP consultations reported fewer GP appointments during the 30-day period; however, savings to the NHS were offset by higher use of other healthcare professionals.

Conclusion: Well-designed training and supervision are needed to ensure PGPs have the right knowledge and can clearly convey healthcare plans to patients. While PGPs may reduce GP workload pressure, they do not necessarily reduce NHS costs.