Work-leave rotation among general practitioners in Norwegian municipalities.

Background: A number of municipalities have introduced work-leave rotation (aka 'North Sea shift') for general practitioners, whereby the doctors alternate between periods of work and leave over the year. We have investigated the reasons for this type of work schedule, its prevalence and scope, and experiences with this form of working.

Material and method: We have undertaken a multiple-case study using data from Statistics Norway, the GP register, municipal documents, brief telephone interviews with doctors working a rotating schedule and in-depth interviews with healthcare leaders. We have performed descriptive analyses of the quantitative data material and thematic analyses of the in-depth interviews.

Results: We identified 25 municipalities that had introduced work-leave rotation for GPs. Of these, 20 participated in our study. Seventeen of these 20 municipalities were in centrality class 5 or 6 (least central). The most common schedule was two weeks of work followed by four weeks of leave. All rotating schedules included out-of-hours duty. The study also included 64 doctors in work-leave rotation schemes, half of whom had been recruited from other general practice positions. Altogether 65 % of the doctors were not specialists in general practice. On average, there were ten applicants for each vacancy announced with work-leave rotation. Based on the interviews with healthcare leaders in the 20 municipalities, we identified four topics: i) The path to the work-leave rotation scheme; ii) Inadequate legal and contractual framework; iii) Work-leave rotation and specialisation in general practice; and iv) Stabilisation, vulnerability and flexibility.

Interpretation: A growing number of GPs are working on a rotating schedule. This form of work appears to recruit GPs to the least central municipalities. The rotating schedules come in various forms. The labour contracts are negotiated locally, and our findings indicate that the legal and contractual basis that regulates these work-leave rotation schemes is inadequate.