The high turnover of GPs at some surgeries is having a detrimental impact on patient care, a new study claims. An investigation by the University of Manchester found that ‘persistent high turnover’ has affected nearly 30 per cent of English practices since 2009, causing more patients to turn to hospital accident and emergency departments and a drop in patients seeing their preferred doctor or obtaining an appointment on the day they called.
The university team defined persistent high turnover as when more than 10 per cent of GPs changed in a practice in at least three consecutive years, which it said was not uncommon. It added that this affected 2,309 of English practices at least once between 2009 and 2019.
These practices were associated with 1.8 per 100 patients more emergency hospital attendances, 5.2% fewer people seeing their preferred doctor, 10.6% fewer people reporting obtaining an appointment on the same day and 1.3% more people having lower overall satisfaction with their practice.
Practices with persistent high turnover tended to be larger, located in more deprived areas and had a higher health burden from serious chronic conditions. The highest levels of ‘persistent high turnover’ were in Cumbria and the North East, South Central and the West Midlands.
The differences, say the team, could be explained by different levels of social deprivation, unequal distribution of the GP workforce, and different pressures on the healthcare system.
The researchers studied an average of 7,526 practices each year from 2007 to 2019. The researchers observed a worrying increase in the practices affected in a year, from 2.7% in 2009 (high turnover in 2007, 2008 and 2009) to 6.3% in 2019 (high turnover in 2017, 2018 and 2019).
The project has been funded by the Health Foundation as part of its Efficiency Research Programme. Co-author Rosa Parisi said: “This study is a wakeup call for primary care and for the first time gives us clarity on one of the major problems affecting it.
“We think high GP turnover is likely to affect continuity of care, and that might explain why avoidable emergency attendances are more likely to happen. Indeed we know from previous studies that continuity of care is deeply important to patients.”
The study also involved two discussion groups with four GPs who welcomed the findings and recognised the need for research in this area. They highlighted workload pressure, limited opportunities and contribution to decision making and the management of their practice, particularly salaried GPs, with lack of funding and investment from the government.
Co-author Professor Evan Kontopantelis said: “There is a desperate need for policies to maximise retention of GPs and personal and professional support, targeting areas which influence job satisfaction and work-life balance. In addition, the current funding formulae do not fully take account of the demands associated with practising in a deprived areas - and this too needs to be addressed."
The report is published in the journal BMJ Quality and Safety today (January 24).
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