Addressing the crisis of GP recruitment and retention: a systematic review

Catherine Marchand; Stephen Peckham

doi:10.3399/bjgp17X689929

Abstract

Background The numbers of GPs and training places in general practice are declining, and retaining GPs in their practices is an increasing problem.

Aim To identify evidence on different approaches to retention and recruitment of GPs, such as intrinsic versus extrinsic motivational determinants.

Design and setting Synthesis of qualitative and quantitative research using seven electronic databases from 1990 onwards (Medline, Embase, Cochrane Library, Health Management Information Consortium [HMIC], Cumulative Index to Nursing and Allied Health Literature (Cinahl), PsycINFO, and the Turning Research Into Practice [TRIP] database).

Method A qualitative approach to reviewing the literature on recruitment and retention of GPs was used. The studies included were English-language studies from Organisation for Economic Cooperation and Development countries. The titles and abstracts of 138 articles were reviewed and analysed by the research team.

Results Some of the most important determinants to increase recruitment in primary care were early exposure to primary care practice, the fit between skills and attributes, and a significant experience in a primary care setting. Factors that seemed to influence retention were subspecialisation and portfolio careers, and job satisfaction. The most important determinants of recruitment and retention were intrinsic and idiosyncratic factors, such as recognition, rather than extrinsic factors, such as income.

Conclusion Although the published evidence relating to GP recruitment and retention is limited, and most focused on attracting GPs to rural areas, the authors found that there are clear overlaps between strategies to increase recruitment and retention. Indeed, the most influential factors are idiosyncratic and intrinsic to the individuals.

INTRODUCTION

The UK government and professional bodies have become increasingly concerned about the declining numbers of GPs. The reasons for this are thought to be related to problems in training, low GP morale, increasing workload pressures on practices, challenges of changing roles, and reductions in pay.¹^–⁴

The number of GPs per 100 000 head of population across England declined from 62 in 2009 to 59.5 in 2012.⁵ Despite Department of Health policy to increase GP training numbers in England to 3250 per annum, GP recruitment has remained persistently below this target, at around 2700 per annum, and since 2005 there has been a gradual decline in the percentage of students choosing general practice as a first choice.⁶ Despite a recruitment record of 2989 in 2015–2016, Health Education England () missed their recruitment goal of 3250 new GP trainees.⁷ Although applications for general practice post-qualifying have substantially increased in 2016, the problem remains in some areas, such as in the North East, North West, and Midlands.⁷^,⁸ This reduction is set against an increasing GP workload due to changing health needs and policies designed to develop more primary and community-based health care.⁹^–¹²

Additional pressure arises from an increase in the numbers of GPs leaving general practice, including an increase in those considering practising abroad.¹³^,¹⁴ Together, under-recruitment of GPs and increased propensity to leave are key factors in the current GP shortage. To address this, NHS England — working with HEE, the Royal College of General Practitioners (RCGP), and the British Medical Association (BMA) — in 2015 published Building the Workforce — the New Deal for General Practice,¹⁵ where they presented the 10-point plan, then in 2016 the General Practice Forward View,¹⁶ both proposing strategies to increase recruitment and reduce turnover in general practice through specific initiatives and further investment in general practice.

As part of the development work for reviewing the 10-point plan and NHS England’s strategy, the Policy Research Unit in Commissioning and the Healthcare System (PRUComm) was asked to review the existing evidence on GP recruitment and retention.¹⁷ The review explored the main dimensions related to recruitment and retention of GPs to identify the intrinsic and extrinsic motivational factors connected to career choices and retention. This study reports on the main findings of the review.

METHOD

To identify relevant evidence, the authors undertook a structured review that synthesised the evidence from reviews on primary care physician recruitment and retention from countries with similar health systems to the UK (for example, Canada and Australia), and UK studies specifically examining GP recruitment and retention and GP training (search terms are outlined in Appendix 1). Articles published in English from 1990 onwards were included.

How this fits in

To support the work of NHS England and Health Education England on the development of the Five Year Forward View, the Department of Health commissioned a review of the evidence of the 10-point plan from Building the Workforce — the New Deal for General Practice from the Policy Research Unit in Commissioning and the Healthcare System. The review examined the evidence on GP recruitment and retention determinants, and found that intrinsic and idiosyncratic factors, such as job satisfaction, were more important than extrinsic factors, such as financial incentives.

Following an initial review, the terms were searched as keywords (appearing in title, abstract, subject, and keyword heading fields) and also mapped against MeSH subject headings, where applicable, to ensure comprehensive coverage. The databases searched were Medline, Embase, Cochrane Library, Health Management Information Consortium (HMIC), Cumulative Index to Nursing and Allied Health Literature (Cinahl), PsycINFO, and the Turning Research Into Practice (TRIP) database (an internet-based source of evidence-based research). The literature search included all journal articles, systematic reviews, meta-analyses, review articles, reports, and grey literature (Table 1 contains the search results). The authors also expanded their data collection to undertake more in-depth searching of the grey literature and conducted hand searches of key journals to provide a more comprehensive analysis and evidence base for policy development. The search was restricted to English-language studies in journals from countries that are part of the Organisation for Economic Cooperation and Development (OECD), and selected articles generally came from countries with similar healthcare systems, such as Canada and Australia.

View this table:

Table 1.

Search results

Duplicates were deleted and a basic initial weeding process was undertaken to exclude irrelevant papers. The research team reviewed the titles and abstracts of identified articles to select relevant studies for inclusion in the review. Original research papers and empirical studies (Figure 1¹⁸) were reviewed, both from the UK and from other countries where relevant.

Figure 1.

Flow chart of identification and inclusion of studies for review. Adapted with permission from the PRISMA statement.¹⁸

RESULTS

There was a degree of overlap between studies that examined retention and which also studied recruitment. However, in order to set the evidence on recruitment and retention determinants, these are presented separately.

Recruitment in general practice

Studies that examine specific recruitment strategies for the GP workforce are scarce.¹⁹ This review suggests that most studies on primary care physician recruitment (for example, GPs and family doctors) have predominantly focused on remote rural locations. However, the authors identified a number of studies that examined the determinants influencing recruitment that would be relevant to general practice. These can be characterised in terms of how they relate to the individual, institutional, and professional contexts of recruitment.

In a study of career choices, Shadbolt and Bunker²⁰ presented determinants that are mainly intrinsic to the individual. These intrinsic factors include physicians’ self-awareness of their skills, and the factors associated with career orientations or choices. These are influenced by demographic variables, lifestyle orientation, and the opportunities for learning and educational development,²⁰^–²³ suggesting that medical graduates primarily look for a career that is stimulating and interesting. One study found that medical students were more attracted towards biomedical or technical forms of medical practice, as opposed to a more holistic form of medicine.²¹

Medical students exposure to, and experience of, general practice has an important effect on preferences for a career in general practice. The authors identified a number of studies that highlighted the important influence on recruitment of the workplace experience, stressing the need for a positive experience from interactions with members of the profession, the length of time spent in general practice, the quality of the practice, and the dedication of the generalists’ faculty.¹⁹^–²¹^,²⁴^–²⁹ In particular, positive experiences were linked to an increased likelihood to choose general practice; especially when the experience occurred at the pre-clinical or early stage.²⁵^,²⁹

Similarly, Campos-Outcalt et al³⁰ found that the best strategies to enlarge the proportion of medical students choosing generalist careers included reform of the medical school curricula with emphasis on generalist training, increasing the size of generalist faculties, and ensuring there is clinical training in family practice training. There is some evidence to show that implementing effective medical school curricula in primary care and establishing primary care honours tracks, developing or expanding primary care fast-track programmes, and developing curricula proposing portfolio careers and profile of new skills²⁰^,²⁸^,³⁰^,³¹ influences students’ career choices. Currently, medical training delivered in general practice, and the proportion of the medical school budget made available for its teaching, is lower than the time dedicated to, and resources available for, teaching related to secondary care.²

Two studies focused on the effect of the modification of admission criteria to identify potential students who are more likely to choose primary care specialisation as part of student selection. They proposed that assessing the community of origin and previous experience of, or interest in, people and social concerns, and discussing future specialty choices be integrated into the admission process.³²^,³³ Providing financial support to students choosing poorly recruiting areas of practice has been shown to have a negative impact on retaining those students when in practice.³⁴ However, increases in student debt from higher tuition fees may make such schemes more attractive, although further research is required.²⁰^,²⁷

Factors influencing recruitment are related to the clinical content, perceived lifestyle, and work context. The clinical content of the role is one of the most important factors influencing career choices.²³ Given this dominance, the negative view of general practice held by medical students — that it is less intellectually stimulating — may explain the lack of interest in this career choice.²⁰^,²³ However, Chellappah and Garnham²¹ concluded that students at the end of their training have a positive image of general practice, suggesting that students’ views change during medical training, but choices regarding eventual specialty are taken earlier in medical school, before these more positive views are formed.

Work climate and work context, such as the support from colleagues, autonomy, flexibility and independence, proximity with patients, the continuity of care, and health promotion, are also key factors affecting recruitment.²⁰^,²¹^,²³^,³⁵^,³⁶ Compatibility with family life and the medical breadth of the discipline also positively influence choosing general practice.³⁶

Shadbolt and Bunker²⁰ have suggested that more attention should be paid to the fit between skills and attributes with intellectual content and demands of primary medical care, by emphasising the lifestyle issues (flexibility or work–life balance), social orientation (patient focused or community based), and the opportunity to gain significant and varied clinical experience in the primary care setting.

Retention of GPs

Few studies explicitly examined how to retain primary care physicians in practice. In the UK, the numbers of GPs registering to work abroad has significantly increased in the past 3 years, and GPs’ intention to quit practice has been increasing: from 8.9% in 2012 to 13.1% in 2015 among GPs <50 years old, and from 54.1% in 2012 to 60.9% in 2015 among GPs aged ≥50 years.¹⁴ Retention can be influenced by a variety of intrinsic and extrinsic factors, including remuneration, income and salary retention schemes, job satisfaction, and career pathway and portfolio.¹⁵^,¹⁶^,³⁷

Although remuneration and retention schemes, such as increases in salary or lump sum payments, are used by the government to retain doctors, there is little evidence of the positive and effective impact of these schemes. Low pay might be a source of dissatisfaction with the job,²⁷ but the evidence suggests that increases in income would not compensate for other sources of job dissatisfaction, such as workload.³⁷

Job satisfaction and job dissatisfaction are significant predictors of GP retention and turnover,³⁸^,³⁹ reflecting the findings of research in the wider management and organisational behaviour literature.⁴⁰^,⁴¹ Job satisfaction varies from time to time within an individual’s career stages. Therefore, it is important to understand both the determinants influencing job satisfaction and dissatisfaction, and also the factors that increase strain in the workplace and in general practice. Job satisfaction and dissatisfaction are related to three factors: job stressors (for example, workload), job characteristics and attributes (for example, job autonomy), and other conditions (for example, practice geographical location).

Job dissatisfaction is most influenced by work-related variables. In particular, these include increased workload intensity and volume to meet the requirements of external agencies, having insufficient time to do the job justice, increased administration and bureaucracy, increased demand and expectation from patients, increasing work complexity, lack of support from colleagues, lack of professional recognition, and long working hours.¹⁴^,³⁹^,⁴⁰^,⁴² More recently, adverse publicity from the media, changes imposed from local primary care organisations, and insufficient resources within the practice have all increased job dissatisfaction.¹³ There is evidence to show that increased work stress and work intensity leads GPs under ‘high strain’ to report higher levels of anxiety, depression, and dissatisfaction than GPs under ‘low strain’, and that the health impacts of stress continued outside of work, which in turn could increase job dissatisfaction and intention to quit the profession.⁴³^,⁴⁴

Job satisfaction is also influenced by expectations about future events.⁴⁵ If doctors perceive that their workload will not reduce, and that demands will always increase, it is likely that they will feel more overwhelmed and less satisfied with their job, and thus more likely to quit. Therefore, feeling more stressed, disillusioned, and overwhelmed amplifies the negative portrayal of GPs in the media and by government, further negatively affecting GPs’ spirit and professional identity.⁴⁶

There is some evidence that job autonomy, the variety of work, the feeling of doing an important job, social support, and a good practice environment positively affect job satisfaction.¹⁴^,³⁹^,⁴⁷ However, GP surveys suggest that a number of these attributes have changed between 2012 and 2015; such as the autonomy in deciding how to do their job and what work to do, the variety of work, and flexibility of working.¹⁴

Changes to general practice over the last 10–15 years have been substantial, and job dissatisfaction could be a result of the changing roles necessitated by professional and organisational changes.³⁸^,⁴⁷ However, job satisfaction is also influenced by a number of other factors, such as the local practice context, work–life flexibility, personal development, and the emotional impact of working as a GP.⁴²^,⁴⁷ Wordsworth et al ⁴⁸ suggested that enhancing the patient care aspects of a GP’s work is more likely to act as a key for retention, and that lack of consultation on changes can lead to dissatisfaction.⁴⁹ Flexibility and part-time working have always been seen as factors that make general practice a more attractive working environment, although this is increasingly seen to be less relevant.⁴⁸^,⁵⁰^–⁵²

Mentorship schemes and opportunities to develop portfolio careers would be welcome at every stage of a GP’s career, not just for senior doctors or towards the end of working lives.²⁰^,²⁶^,²⁹ Two papers suggest that a wider choice of long-term career paths, such as subspecialisation and portfolio careers (for example, dermatology or paediatrics), is important for both the recruitment and retention of GPs. It is also suggested that an increase in satisfaction of intellectual and altruistic needs, and functional flexibility within their practice, could improve satisfaction and fulfilment, and consequently GPs’ retention.²⁰^,²⁹ Providing learning and development activities, such as developing management skills, could support GP recruitment and retention, providing an opportunity for students to map out development pathways and provide variety within a physician’s role.

DISCUSSION

Summary

Three elements are relevant to GP recruitment: individual, institutional, and professional factors. In addition, providing students with appropriate opportunities for contact with, and positive exposure to, general practice and GPs is critical, as well as widening the opportunities for students and GPs so that junior doctors’ specialisation choices can reflect more individual student characteristics. The main determinants of retention are job satisfaction (versus dissatisfaction), the influence of job stress, job attributes and characteristics, and other conditions, such as the geographical location of the practice. All seem related to career pathways and portfolio.

Based on this review of the evidence, the authors would support strategies that provide long-term investment in general practice. Current proposals to increase the proportion of NHS funding in primary care are therefore welcome. The evidence suggests that providing the right environment and opportunity for GPs to focus on supporting patients as medical professionals is crucial, requiring strategies that reduce workload while retaining the core attributes of general practice. However, strategies should also include opportunities for GPs to develop wider interests and skills, and should take into consideration both recruitment and retention simultaneously. From this review, there appear to be three key lessons that should underpin national and local policies:

review the curricula in medical schools and emphasise the importance of exposure to general practice;
job satisfaction is the main predictor of retention and is influenced by workload stress and future anticipation, and thus strategies that reduce workload are required; and
financial inducements (golden handcuffs) are not necessarily effective.

Strengths and limitations

Overall, the published evidence in relation to GP recruitment and retention is limited and mostly focuses on attracting GPs to rural areas — particularly in Australia. The review shows an overlap in the determinants of recruitment and retention.⁴⁷ Despite this, the evidence suggests that there are some potential factors that may usefully support the development of specific strategies for supporting the recruitment and retention of GPs. These are summarised in Table 2 and Appendix 2. Although most strategies proposed by the 10-point plan from the document Building the Workforce — the New Deal for General Practice and the General Practice Forward View are not based on strong evidence, some determinants might help with the GP workforce crisis.¹⁵^,¹⁶

View this table:

Table 2.

Summary of evidence to support GP recruitment and retention, using a framework adapted from the 10-point plan from Building the Workforce — the New Deal for General Practice document.¹⁵

Implications for research and practice

Newton et al found that retirement at 60 years old was a goal for both happy GPs — in order to do other things or because they feel they have ‘done their bit’ — and those GPs who no longer had the resilience to cope with work stress.⁵⁰ In their study, Roos et al showed that, although 83.7% of GP trainees and newly qualified GPs would choose to be a physician again, only 78.4% would choose general practice as a specialisation.³⁶ One clear message from the literature is that expectations about the future — whether as a new GP or because of future developments in general practice — affect both recruitment and retention.⁴⁵^,⁵³

One area not fully explored in the literature identified for this review was the recruitment policy of medical schools, given that that there are career choice determinants influencing the recruitment of GPs in medical school. It would be interesting in the future to explore the role of health policy on the specific recruitment policy of medical schools, and this is likely to be influenced by the findings of the joint HEE and Medical Schools Council review chaired by Professor Val Wass.⁵⁴^,⁵⁵ The General Practice Forward View has suggested recruitment at the international level. International recruitment was outside the scope of this review. A post-hoc analysis shows a lack of evidence of the long-term beneficial effects of such recruitment strategy.⁵⁶^–⁶⁰ Short-term policies, such as international recruitment, financial bonuses, and other incentive packages, may respond to immediate needs, but are not long-term solutions.

Acknowledgments

The authors thank Ms Anna Peckham, consultant librarian, for her assistance in the literature search.

Appendix 1. Search terms

Key terms	Combined with:
General practitioner	Recruitment
GPs	Recruitment strategy^a
General practice	Personnel recruitment
Family practitioner^a	Employment
Family practice	Career choice
Family physician^a	Personnel turnover
Family doctor^a	Motivation
Primary care physician^a	Retention
Primary care doctor^a	GP retention
Primary care practitioner^a	Retirement Early retirement

↵a Truncation.

Appendix 2. Characteristics of included reviews on determinant of recruitment and retention of GPs

Authors	Year	Countries	Article type	Topic	Method	Relevance	Quality
Buchbinder SB et al ⁴⁶	2001	US	Cohort study	Primary care physician, job satisfaction and turnover	Questionnaire survey	Weak: cohort from the US and data from 1987 to 1991	Good
Buciuniene I et al ⁴²	2005	Lithuania	Original research	Healthcare reform and job satisfaction	Self-administrated anonymous questionnaires	Weak: GPs and policy from Lithuania	Average/weak: cross-sectional and statistical analyses simplistic (no regression, only correlations)
Bustinza R et al ³⁴	2009	Canada	Cohort study	Training programme, GP retention in rural area	Used of secondary data and questionnaires	Average: Canada has a similar primary care context but the study was in a rural context	Good
Campos-Outcalt D et al ³⁰	1995	US	Review/quality assessment	Curricula, role models, research support, career choice	Literature search: Medline, PsycINFO, Current Contents, Expanded Academic Index	Average, the article presents three elements influencing career choice, but the article is quite old	Average: the methods are very detailed. Very few articles were included in the results section due to the lack of quality articles fitting their 70 criteria
CfWI⁵¹	2014	UK	Review/report	GP workforce	N/A	High	Good: because it gives an overview of the GP workforce in the UK
Chellappah M, Garnham L²¹	2014	UK	Original research	Medical student attitude towards general practice	Questionnaire design	High	Weak: not generalisable (specific to one college). Measurement scale not used
Crampton PES et al ²²	2013	Australia, US, Canada, NZ, South Africa, Japan	Systematic literature review	Undergraduate clinical placements, underserved areas	Database searches, inclusion and exclusion criteria, data extraction, and so on	Weak	High
Dale J et al ⁴³	2015	UK (West Midlands)	Cross-sectional study	Retention of GPs	Online questionnaire with free-text section	High	Good: because it questioned the proposition that general practice is in crisis
Dayan M et al ³⁷	2014	UK	Report	GP workforce crisis	N/A	Good	Average
Doran N et al ⁴⁷	2016	UK	Mixed-methods research	Why GPs leave the NHS	Online questionnaire with qualitative interviews	High	Good
Evans J et al ⁵²	2000	UK	Cohort study	Medical graduates and flexible/part-time working in medicine	Survey with free-text comment. Reported mainly the qualitative data	Weak: medical graduate in general not only future GPs, also the data come from 1977, 1988, and 1993	Average: used mainly qualitative data coming from the free-text comment. The percentage of comment on flexible and part time is less than 9% for the three cohorts
Feeley TH⁵³	2003	N/A	Narrative literature review	Retention in rural primary care physicians	N/A	Weak	Weak
Geyman JP et al³³	2000	US	Study	Educating GPs for rural practice	Comprehensive literature search: Medline, Health STAR databases	Weak, but the recommendations are interesting	Average/weak: little analysis, only looked at programmes
Gibson J et al¹⁴	2015	UK	Report, survey	GP work/life survey	Questionnaire	Good	Average: it is a report.
Groenewegen PP et al⁴⁴	1991	US	Review of the literature	GP, effective workload, job satisfaction	N/A	Good	Average: no method but definition and theorisation is interesting
Halaas GW et al ²⁴	2008	US	Study	Recruitment and retention of rural physicians	Analysed data from a recruitment programme	Good, but the results are linked to the rural context	Average: no hypothesis, nor hypothesis testing, but 37-year trend studied
Harding A et al ²	2015	UK	Cross-sectional study	Teaching and general practice	Review of past national survey and questionnaire survey	Good	Good
Hemphill E et al ⁶¹	2007	Australia	Mixed design	GP rural recruitment	Three sources of data collection: GP survey, data collected from a convenient sample of students, and interviews with recruiting agencies	Weak	Average
Humphreys J et al ⁴⁹	2001	Australia	Critical review	Rural medical workforce retention	Australian and international database: ATSI Health, Consumer service, AusportMed, Family & Society, and so on	Good	Average: issues with method inclusion/exclusion criteria
Illing J et al ²⁵	2003	UK	Review of evidence	Learning in practice (preregistration house officers) and general practice	Literature search: Embrase, Medline, ERIC, FirstSearch, PsycINFO, www.timelit.org.uk, www.educationgp.com	Good	Average: methods inclusion and exclusion criteria not presented
Landry M et al ²⁶	2011	Canada	Original study	Recruitment and retention of doctors and local training (rural)	Short survey	Good but the results are linked to the rural context	Good: methods well presented, the analyses are adequate
Lee DM, Nichols T ²⁷	2014	US, Canada	Case study, review	Physician recruitment and retention, rural and underserved areas	Literature review	Weak: but suggestions for different factors influencing recruitment and retention	Average: the review method is described but the case study choice is not explained
Newton J et al ⁵⁰	2004	UK (Northern Deanery)	Original study	Job dissatisfaction and early retirement	Qualitative study: interviews, using a purposefully drawn sample from seven sub-groups of responders	Good	Average: small number of interviewees
O’Connor DB et al ⁴⁵	2000	UK (Liverpool)	Preliminary study	Job strain and blood pressure in general practice	Questionnaire and ambulatory blood pressure procedure	High: relationship between job strain and blood pressure	Good
Petchey R et al ²³	1997	UK	Original study	Junior doctors’ perceptions of general practice as a career	Qualitative study: interviews, using an heterogeneous sample	High	Weak: little theoretical. development
Roos M et al ³⁶	2014	Czech Republic, Denmark, Germany, Italy, Norway, Portugal, UK	Original cross-sectional study	Motivation for career choice and job satisfaction: GP trainees and newly qualified GPs	Questionnaire/survey	High	Good
Rosenthal TC ³²	2000	US	Review	Rural training tracts	N/A	Weak: but interesting insight	Weak
Schwartz MD et al ²⁸	2005	US	Reflection	Student interest in generalist career	N/A	High	Weak: recommendations without original study, nor based on evidence from various articles
Shadbolt N, Bunker J ²⁰	2009	Australia	Review	Career choice determinants	N/A	High	Weak: no method
Sibbald B et al ³⁹	2003	England	National survey	Job satisfaction and retirement	Survey	High	Good
Stapleton G et al ⁶²	2014	English-speaking countries	Review, ethical criteria	Primary care physicians	Database: Web of Knowledge	Weak	Average: presentation of methods
Van Ham I et al ⁴⁰	2006	UK, US, Australia	Systematic review	GPs and job satisfaction	Two strategies: database and snowball methods	High	High
Verma P et al ¹⁹	2016	UK, US, Canada, Australia, Japan, NZ, Norway, Chile	Systematic review	Strategies to recruit and retain	Literature search: Medline, Embase, and Central, 1974–2013	High	High
Williamson JW et al ³¹	1993	US	Comparative studies	Primary care, health systems change	N/A	Weak	Weak: no method
Wordsworth S et al ⁴⁸	2004	UK	Original study	Preferences for general practice jobs	Discrete-choice experiment	Good	Good
Young R, Leese B ²⁹	1999	UK	Discussion paper/review	Recruitment and retention of GPs in the UK	Literature search: Medline, BIDS-EMBASE, IBSS, HELMIS, survey of articles in recent issues of relevant professional journals	High	Average: little theoretical development and evidence

ATSI = Aboriginal and Torres Strait Islander. CfWI = Centre for Workforce Improvement. ERIC = Education Resources Information Centre. HELMIS = Health Management Information Service. IBSS: = International Bibliography of the Social Sciences.

Notes

Funding

The review was commissioned by the Department of Health from the Policy Research Unit in Commissioning and the Healthcare System (PRUComm). The views expressed are those of the researchers and not necessarily those of the Department of Health. The funding reference number is PHSRHF58.

Ethical approval

Not applicable.

Provenance

Freely submitted; externally peer reviewed.

Competing interests

The authors have declared no competing interests.

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Received August 17, 2016.
Revision requested October 18, 2016.
Accepted December 19, 2016.

REFERENCES

1.↵
1. Gillam S,
2. Siriwardena AN
(2014) Evidence-based healthcare and quality improvement. Qual Prim Care 22(3):125–132.
OpenUrl
2.↵
1. Harding A,
2. Rosenthal J,
3. Al-Seaidy M,
4. et al.
(2015) Br J Gen Pract, Provision of medical student teaching in UK general practices: a cross-sectional questionnaire study. DOI: https://doi.org/10.3399/bjgp15X685321&#39.
3.
1. Hobbs FD,
2. Bankhead C,
3. Mukhtar T,
4. et al.
(2016) Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007–14. Lancet 387(10035):2323–2330.
OpenUrl CrossRef PubMed
4.↵
1. Jones D
(2015) Br J Gen Pract, GP recruitment and retention. DOI: https://doi.org/10.3399/bjgp15X684721&#39.
5.↵
1. NHS
(2013) NHS workforce: summary of staff in the NHS: results from September 2012 census, The Information Centre for health and social care. http://content.digital.nhs.uk/catalogue/PUB10392/nhs-staf-2002-2012-over-rep.pdf (accessed 24 Feb 2017).
6.↵
1. Svirko E,
2. Goldacre MJ,
3. Lambert T
(2013) Career choices of the United Kingdom medical graduates of 2005, 2008 and 2009: questionnaire surveys. Med Teach 35(5):365–375.
OpenUrl CrossRef PubMed
7.↵
1. Thomas R
(Oct 20, 2016) Health Serv J, HEE misses GP training target despite record recruitment. https://www.hsj.co.uk/sectors/primary-care/hee-misses-gp-training-target-despite-record-recruitment/7011651.article (accessed 24 Feb 2017).
8.↵
1. Millet D
(Jul 21, 2016) GP, Health education chiefs identify 5,000 GP recruitment target as ‘greatest risk’ http://www.gponline.com/health-education-chiefs-identify-5000-gp-recruitment-target-greatest-risk/article/1403071 (accessed 13 Feb 2017).
9.↵
1. Department of Health
(1996) Primary care delivering the future (DH, London).
10.
1. Department of Health
(1997) The new NHS: modern, dependable (DH, London).
11.
1. Department of Health
(2000) The NHS plan: a plan for investment, a plan for reform (DH, London).
12.↵
1. Department of Health
(2006) Our health, our care, our say: a new direction for community services (DH, London).
13.↵
1. Davis J
(Aug 6, 2015) Pulse, 800 GPs applying for permit to work abroad every year. http://www.pulsetoday.co.uk/your-practice/regulation/800-gps-applying-for-permit-to-work-abroad-every-year/20010699.article (accessed 13 Feb 2017).
14.↵
1. Gibson J,
2. Checkland K,
3. Coleman A,
4. et al.
(2015) Eighth national GP worklife survey (Policy Research Unit in Commissioning and the Healthcare System, Manchester) http://www.population-health.manchester.ac.uk/healtheconomics/research/Reports/EighthNationalGPWorklifeSurveyreport/EighthNationalGPWorklifeSurveyreport.pdf (accessed 15 Feb 2017).
15.↵
1. Royal College of General Practitioners,
2. British Medical Association,
3. NHS England,
4. Health Education England
(2015) Building the workforce — the new deal for general practice, https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/01/building-the-workforce-new-deal-gp.pdf (accessed 13 Feb 2017).
16.↵
1. NHS England
(2016) General practice forward view, https://www.england.nhs.uk/gp/gpfv/ (accessed 15 Feb 2017).
17.↵
1. Peckham S,
2. Marchand C,
3. Peckham A
(2016) General practitioner recruitment and retention: an evidence synthesis. Final report (Policy Research Unit in Commisioning and the Healthcare System, Canterbury) https://kar.kent.ac.uk/58788/1/PRUComm%20General%20practitioner%20recruitment%20and%20retention%20review%20Final%20Report.pdf (accessed 13 Feb 2017).
18.↵
1. Moher D,
2. Liberati A,
3. Tetzlaff J,
4. Altman DG,
5. for the PRISMA Group
(2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535.
OpenUrl FREE Full Text
19.↵
1. Verma P,
2. Ford JA,
3. Stuart A,
4. et al.
(2016) A systematic review of strategies to recruit and retain primary care doctors. BMC Health Serv Res 16:126.
OpenUrl CrossRef PubMed
20.↵
1. Shadbolt N,
2. Bunker J
(2009) Choosing general practice: a review of career choice determinants. Aust Fam Physician 38(1–2):53–55.
OpenUrl PubMed
21.↵
1. Chellappah M,
2. Garnham L
(2014) Medical students’ attitudes towards general practice and factors affecting career choice: a questionnaire study. London J Prim Care 6(6):117–123.
OpenUrl
22.↵
1. Crampton PES,
2. McLachlan JC,
3. Illing JC
(2013) A systematic literature review of undergraduate clinical placements in underserved areas. Med Educ 47(10):969–978.
OpenUrl CrossRef PubMed
23.↵
1. Petchey R,
2. Williams J,
3. Baker M
(1997) ‘Ending up a GP’: a qualitative study of junior doctors’ perceptions of general practice as a career. Fam Pract 14(3):194–198.
OpenUrl CrossRef PubMed
24.↵
1. Halaas GW,
2. Zink T,
3. Finstad D,
4. et al.
(2008) Recruitment and retention of rural physicians: outcomes from the rural physician associate program of Minnesota. J Rural Health 24(4):345–352.
OpenUrl PubMed
25.↵
1. Illing J,
2. Van Zwanenberg T,
3. Cunningham WF,
4. et al.
(2003) Preregistration house officers in general practice: review of evidence. BMJ 326(7397):1019–1022.
OpenUrl Abstract/FREE Full Text
26.↵
1. Landry M,
2. Schofield A,
3. Bordage R,
4. Belanger M
(2011) Improving the recruitment and retention of doctors by training medical students locally. Med Educ 45:1121–1129.
OpenUrl CrossRef PubMed
27.↵
1. Lee DM,
2. Nichols T
(2014) Physician recruitment and retention in rural and underserved areas. Int J Health Care Qual Assur 27(7):642–652.
OpenUrl
28.↵
1. Schwartz MD,
2. Basco WT Jr.,
3. Grey MR,
4. et al.
(2005) Rekindling student interest in generalist careers. Ann Intern Med 142(8):715–724.
OpenUrl CrossRef PubMed
29.↵
1. Young R,
2. Leese B
(1999) Recruitment and retention of general practitioners in the UK: what are the problems and solutions? Br J Gen Pract 49(447):829–833.
OpenUrl Abstract/FREE Full Text
30.↵
1. Campos-Outcalt D,
2. Senf J,
3. Watkins AJ,
4. Bastacky S
(1995) The effects of medical school curricula, faculty role models, and biomedical research support on choice of generalist physician careers: a review and quality assessment of the literature. Acad Med 70(7):611–619.
OpenUrl PubMed
31.↵
1. Williamson JW,
2. Walters K,
3. Cordes DL
(1993) Primary care, quality improvement, and health systems change. Am J Med Qual 8(2):37–44.
OpenUrl CrossRef PubMed
32.↵
1. Rosenthal TC
(2000) Outcomes of rural training tracks: a review. J Rural Health 16(3):213–216.
OpenUrl PubMed
33.↵
1. Geyman JP,
2. Hart LG,
3. Norris TE,
4. et al.
(2000) Educating generalist physicians for rural practice: how are we doing? J Rural Health 16(1):56–80.
OpenUrl PubMed
34.↵
1. Bustinza R,
2. Gagnon S,
3. Burigusa G
(2009) [The decentralized training programme and the retention of general practitioners in Quebec’s Lower St Lawrence Region]. [Article in French]. Can Fam Physician 55(9):e29–e34.
OpenUrl Abstract/FREE Full Text
35.↵
1. Hemphill E,
2. Kulik CT
(2011) Segmenting a general practitioner market to improve recruitment outcomes. Aust Health Rev 35(2):117–123.
OpenUrl PubMed
36.↵
1. Roos M,
2. Watson J,
3. Wensing M,
4. Peters-Klimm F
(2014) Motivation for career choice and job satisfaction of GP trainees and newly qualified GPs across Europe: a seven countries cross-sectional survey. Educ Prim Care 25(4):202–210.
OpenUrl PubMed
37.↵
1. Dayan M,
2. Arora S,
3. Rosen R,
4. Curry N
(2014) Is general practice in crisis? (Nuffield Trust, London).
38.↵
1. Sibbald B,
2. Enzer I,
3. Cooper C,
4. et al.
(2000) GP job satisfaction in 1987, 1990 and 1998: lessons for the future? Fam Pract 17(5):364–371.
OpenUrl CrossRef PubMed
39.↵
1. Sibbald B,
2. Bojke C,
3. Gravelle H
(2003) National survey of job satisfaction and retirement intentions among general practitioners in England. BMJ 326(7379):22.
OpenUrl Abstract/FREE Full Text
40.↵
1. Van Ham I,
2. Verhoeven AAH,
3. Groenier KH,
4. et al.
(2006) Job satisfaction among general practitioners: a systematic literature review. Eur J Gen Pract 12(4):174–180.
OpenUrl CrossRef PubMed
41.↵
1. Griffeth RW,
2. Hom PW,
3. Gaertner S
(2000) A meta-analysis of antecedents and correlates of employee turnover: update, moderator tests, and research implications for the next millennium. J Manag 26(3):463–488.
OpenUrl CrossRef
42.↵
1. Buciuniene I,
2. Blazeviciene A,
3. Bliudziute E
(2005) Health care reform and job satisfaction of primary health care physicians in Lithuania. BMC Fam Pract 6(1):10.
OpenUrl CrossRef PubMed
43.↵
1. Dale J,
2. Potter R,
3. Owen K,
4. et al.
(2015) Retaining the general practitioner workforce in England: what matters to GPs? A cross-sectional study. BMC Fam Pract 16:140.
OpenUrl
44.↵
1. Groenewegen PP,
2. Hutten JB
(1991) Workload and job satisfaction among general practitioners: a review of the literature. Soc Sci Med 32(10):1111–1119.
OpenUrl CrossRef PubMed
45.↵
1. O’Connor DB,
2. O’Connor R,
3. White B,
4. Bundred P
(2000) Job strain and ambulatory blood pressure in British general practitioners: a preliminary study. Psychol Health Med 5(3):241–250.
OpenUrl
46.↵
1. Buchbinder SB,
2. Wilson M,
3. Melick CF,
4. Powe NR
(2001) Primary care physician job satisfaction and turnover. Am J Manag Care 7(7):701–713.
OpenUrl PubMed
47.↵
1. Doran N,
2. Fox F,
3. Rodham K,
4. et al.
(2016) Br J Gen Pract, Lost to the NHS: a mixed methods study of why GPs leave practice early in England. DOI: https://doi.org/10.3399/bjgp16X683425&#39.
48.↵
1. Wordsworth S,
2. Skåtun D,
3. Scott A,
4. French F
(2004) Preferences for general practice jobs: a survey of principals and sessional GPs. Br J Gen Pract 54(507):740–746.
OpenUrl PubMed
49.↵
1. Humphreys J,
2. Jones J,
3. Jones M,
4. et al.
(2001) A critical review of rural medical workforce retention in Australia. Aust Health Rev 24(4):91–102.
OpenUrl PubMed
50.↵
1. Newton J,
2. Luce A,
3. Van Zwanenberg T,
4. Firth-Cozens J
(2004) Job dissatisfaction and early retirement: a qualitative study of general practitioners in the Northern Deanery. Prim Health Care Res Dev 5(1):68–76.
OpenUrl
51.↵
1. Centre for Workforce Intelligence
(2014) In-depth review of the general practitioner workforce (CfWI, London).
52.↵
1. Evans J,
2. Goldacre MJ,
3. Lambert TW
(2000) Views of UK medical graduates about flexible and part-time working in medicine: a qualitative study. Med Educ 34(5):355–362.
OpenUrl CrossRef PubMed
53.↵
1. Feeley TH
(2003) Using the theory of reasoned action to model retention in rural primary care physicians. J Rural Health 19(3):245–251.
OpenUrl PubMed
54.↵
1. Matthews-King A
(Mar 2, 2016) Pulse, Education bosses launch landmark review into GP attitude in medical schools. http://www.pulsetoday.co.uk/your-practice/practice-topics/education/education-bosses-launch-landmark-review-into-gp-attitude-in-medical-schools/20031274.fullarticle (accessed 13 Feb 2017).
55.↵
1. Wass V,
2. Gregory S,
3. Petty-Saphon K
(2016) By choice — not by chance: supporting medical students towards future careers in general practice (Medical Schools Council and Health Education England, London).
56.↵
1. Bradby H
(2014) International medical migration: a critical conceptual review of the global movements of doctors and nurses. Health (London) 18(6):580–596.
OpenUrl
57.
1. Buchan J,
2. Dovlo D
(2004) International recruitment of health workers to the UK: a report for DFID: final report, Department for International Development Health Systems Resource Centre (DFID HSRC, London).
58.
1. Legido-Quigley H,
2. Saliba V,
3. McKee M
(2015) Exploring the experiences of EU qualified doctors working in the United Kingdom: a qualitative study. Health Policy 119(4):494–502.
OpenUrl
59.
1. Lozano M,
2. Meardi G,
3. Martín-Artiles A
(2015) International recruitment of health workers. British Lessons for Europe? Emerging concerns and future research recommendations. Int J Health Serv 45(2):306–319.
OpenUrl CrossRef PubMed
60.↵
1. Young R,
2. Noble J,
3. Mahon A,
4. et al.
(2010) Evaluation of international recruitment of health professionals in England. J Health Serv Res Policy 15(4):195–203.
OpenUrl CrossRef PubMed
61.↵
1. Hemphill E,
2. Dunn S,
3. Barich H,
4. Infante R
(2007) Recruitment and retention of rural general practitioners: a marketing approach reveals new possibilities. Aust J Rural Health 15(6):360–367.
OpenUrl PubMed
62.↵
1. Stapleton G,
2. Schroder-Back P,
3. Brand H,
4. Townend D
(2014) Health inequalities and regional specific scarcity in primary care physicians: ethical issues and criteria. Int J Public Health 59(3):449–455.
OpenUrl

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[1] 1.↵
Gillam S,
Siriwardena AN
(2014) Evidence-based healthcare and quality improvement. Qual Prim Care 22(3):125–132.
OpenUrl

[2] Gillam S,

[3] Siriwardena AN

[4] 2.↵
Harding A,
Rosenthal J,
Al-Seaidy M,
et al.
(2015) Br J Gen Pract, Provision of medical student teaching in UK general practices: a cross-sectional questionnaire study. DOI: https://doi.org/10.3399/bjgp15X685321&#39.

[5] Harding A,

[6] Rosenthal J,

[7] Al-Seaidy M,

[8] et al.

[9] 3.
Hobbs FD,
Bankhead C,
Mukhtar T,
et al.
(2016) Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007–14. Lancet 387(10035):2323–2330.
OpenUrl CrossRef PubMed

[10] Hobbs FD,

[11] Bankhead C,

[12] Mukhtar T,

[13] et al.

[14] 4.↵
Jones D
(2015) Br J Gen Pract, GP recruitment and retention. DOI: https://doi.org/10.3399/bjgp15X684721&#39.

[15] Jones D

[16] 5.↵
NHS
(2013) NHS workforce: summary of staff in the NHS: results from September 2012 census, The Information Centre for health and social care. http://content.digital.nhs.uk/catalogue/PUB10392/nhs-staf-2002-2012-over-rep.pdf (accessed 24 Feb 2017).

[17] NHS

[18] 6.↵
Svirko E,
Goldacre MJ,
Lambert T
(2013) Career choices of the United Kingdom medical graduates of 2005, 2008 and 2009: questionnaire surveys. Med Teach 35(5):365–375.
OpenUrl CrossRef PubMed

[19] Svirko E,

[20] Goldacre MJ,

[21] Lambert T

[22] 7.↵
Thomas R
(Oct 20, 2016) Health Serv J, HEE misses GP training target despite record recruitment. https://www.hsj.co.uk/sectors/primary-care/hee-misses-gp-training-target-despite-record-recruitment/7011651.article (accessed 24 Feb 2017).

[23] Thomas R

[24] 8.↵
Millet D
(Jul 21, 2016) GP, Health education chiefs identify 5,000 GP recruitment target as ‘greatest risk’ http://www.gponline.com/health-education-chiefs-identify-5000-gp-recruitment-target-greatest-risk/article/1403071 (accessed 13 Feb 2017).

[25] Millet D

[26] 9.↵
Department of Health
(1996) Primary care delivering the future (DH, London).

[27] Department of Health

[28] 10.
Department of Health
(1997) The new NHS: modern, dependable (DH, London).

[29] Department of Health

[30] 11.
Department of Health
(2000) The NHS plan: a plan for investment, a plan for reform (DH, London).

[31] Department of Health

[32] 12.↵
Department of Health
(2006) Our health, our care, our say: a new direction for community services (DH, London).

[33] Department of Health

[34] 13.↵
Davis J
(Aug 6, 2015) Pulse, 800 GPs applying for permit to work abroad every year. http://www.pulsetoday.co.uk/your-practice/regulation/800-gps-applying-for-permit-to-work-abroad-every-year/20010699.article (accessed 13 Feb 2017).

[35] Davis J

[36] 14.↵
Gibson J,
Checkland K,
Coleman A,
et al.
(2015) Eighth national GP worklife survey (Policy Research Unit in Commissioning and the Healthcare System, Manchester) http://www.population-health.manchester.ac.uk/healtheconomics/research/Reports/EighthNationalGPWorklifeSurveyreport/EighthNationalGPWorklifeSurveyreport.pdf (accessed 15 Feb 2017).

[37] Gibson J,

[38] Checkland K,

[39] Coleman A,

[40] et al.

[41] 15.↵
Royal College of General Practitioners,
British Medical Association,
NHS England,
Health Education England
(2015) Building the workforce — the new deal for general practice, https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/01/building-the-workforce-new-deal-gp.pdf (accessed 13 Feb 2017).

[42] Royal College of General Practitioners,

[43] British Medical Association,

[44] NHS England,

[45] Health Education England

[46] 16.↵
NHS England
(2016) General practice forward view, https://www.england.nhs.uk/gp/gpfv/ (accessed 15 Feb 2017).

[47] NHS England

[48] 17.↵
Peckham S,
Marchand C,
Peckham A
(2016) General practitioner recruitment and retention: an evidence synthesis. Final report (Policy Research Unit in Commisioning and the Healthcare System, Canterbury) https://kar.kent.ac.uk/58788/1/PRUComm%20General%20practitioner%20recruitment%20and%20retention%20review%20Final%20Report.pdf (accessed 13 Feb 2017).

[49] Peckham S,

[50] Marchand C,

[51] Peckham A

[52] 18.↵
Moher D,
Liberati A,
Tetzlaff J,
Altman DG,
for the PRISMA Group
(2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535.
OpenUrl FREE Full Text

[53] Moher D,

[54] Liberati A,

[55] Tetzlaff J,

[56] Altman DG,

[57] for the PRISMA Group

[58] 19.↵
Verma P,
Ford JA,
Stuart A,
et al.
(2016) A systematic review of strategies to recruit and retain primary care doctors. BMC Health Serv Res 16:126.
OpenUrl CrossRef PubMed

[59] Verma P,

[60] Ford JA,

[61] Stuart A,

[62] et al.

[63] 20.↵
Shadbolt N,
Bunker J
(2009) Choosing general practice: a review of career choice determinants. Aust Fam Physician 38(1–2):53–55.
OpenUrl PubMed

[64] Shadbolt N,

[65] Bunker J

[66] 21.↵
Chellappah M,
Garnham L
(2014) Medical students’ attitudes towards general practice and factors affecting career choice: a questionnaire study. London J Prim Care 6(6):117–123.
OpenUrl

[67] Chellappah M,

[68] Garnham L

[69] 22.↵
Crampton PES,
McLachlan JC,
Illing JC
(2013) A systematic literature review of undergraduate clinical placements in underserved areas. Med Educ 47(10):969–978.
OpenUrl CrossRef PubMed

[70] Crampton PES,

[71] McLachlan JC,

[72] Illing JC

[73] 23.↵
Petchey R,
Williams J,
Baker M
(1997) ‘Ending up a GP’: a qualitative study of junior doctors’ perceptions of general practice as a career. Fam Pract 14(3):194–198.
OpenUrl CrossRef PubMed

[74] Petchey R,

[75] Williams J,

[76] Baker M

[77] 24.↵
Halaas GW,
Zink T,
Finstad D,
et al.
(2008) Recruitment and retention of rural physicians: outcomes from the rural physician associate program of Minnesota. J Rural Health 24(4):345–352.
OpenUrl PubMed

[78] Halaas GW,

[79] Zink T,

[80] Finstad D,

[81] et al.

[82] 25.↵
Illing J,
Van Zwanenberg T,
Cunningham WF,
et al.
(2003) Preregistration house officers in general practice: review of evidence. BMJ 326(7397):1019–1022.
OpenUrl Abstract/FREE Full Text

[83] Illing J,

[84] Van Zwanenberg T,

[85] Cunningham WF,

[86] et al.

[87] 26.↵
Landry M,
Schofield A,
Bordage R,
Belanger M
(2011) Improving the recruitment and retention of doctors by training medical students locally. Med Educ 45:1121–1129.
OpenUrl CrossRef PubMed

[88] Landry M,

[89] Schofield A,

[90] Bordage R,

[91] Belanger M

[92] 27.↵
Lee DM,
Nichols T
(2014) Physician recruitment and retention in rural and underserved areas. Int J Health Care Qual Assur 27(7):642–652.
OpenUrl

[93] Lee DM,

[94] Nichols T

[95] 28.↵
Schwartz MD,
Basco WT Jr.,
Grey MR,
et al.
(2005) Rekindling student interest in generalist careers. Ann Intern Med 142(8):715–724.
OpenUrl CrossRef PubMed

[96] Schwartz MD,

[97] Basco WT Jr.,

[98] Grey MR,

[99] et al.

[100] 29.↵
Young R,
Leese B
(1999) Recruitment and retention of general practitioners in the UK: what are the problems and solutions? Br J Gen Pract 49(447):829–833.
OpenUrl Abstract/FREE Full Text

[101] Young R,

[102] Leese B

[103] 30.↵
Campos-Outcalt D,
Senf J,
Watkins AJ,
Bastacky S
(1995) The effects of medical school curricula, faculty role models, and biomedical research support on choice of generalist physician careers: a review and quality assessment of the literature. Acad Med 70(7):611–619.
OpenUrl PubMed

[104] Campos-Outcalt D,

[105] Senf J,

[106] Watkins AJ,

[107] Bastacky S

[108] 31.↵
Williamson JW,
Walters K,
Cordes DL
(1993) Primary care, quality improvement, and health systems change. Am J Med Qual 8(2):37–44.
OpenUrl CrossRef PubMed

[109] Williamson JW,

[110] Walters K,

[111] Cordes DL

[112] 32.↵
Rosenthal TC
(2000) Outcomes of rural training tracks: a review. J Rural Health 16(3):213–216.
OpenUrl PubMed

[113] Rosenthal TC

[114] 33.↵
Geyman JP,
Hart LG,
Norris TE,
et al.
(2000) Educating generalist physicians for rural practice: how are we doing? J Rural Health 16(1):56–80.
OpenUrl PubMed

[115] Geyman JP,

[116] Hart LG,

[117] Norris TE,

[118] et al.

[119] 34.↵
Bustinza R,
Gagnon S,
Burigusa G
(2009) [The decentralized training programme and the retention of general practitioners in Quebec’s Lower St Lawrence Region]. [Article in French]. Can Fam Physician 55(9):e29–e34.
OpenUrl Abstract/FREE Full Text

[120] Bustinza R,

[121] Gagnon S,

[122] Burigusa G

[123] 35.↵
Hemphill E,
Kulik CT
(2011) Segmenting a general practitioner market to improve recruitment outcomes. Aust Health Rev 35(2):117–123.
OpenUrl PubMed

[124] Hemphill E,

[125] Kulik CT

[126] 36.↵
Roos M,
Watson J,
Wensing M,
Peters-Klimm F
(2014) Motivation for career choice and job satisfaction of GP trainees and newly qualified GPs across Europe: a seven countries cross-sectional survey. Educ Prim Care 25(4):202–210.
OpenUrl PubMed

[127] Roos M,

[128] Watson J,

[129] Wensing M,

[130] Peters-Klimm F

[131] 37.↵
Dayan M,
Arora S,
Rosen R,
Curry N
(2014) Is general practice in crisis? (Nuffield Trust, London).

[132] Dayan M,

[133] Arora S,

[134] Rosen R,

[135] Curry N

[136] 38.↵
Sibbald B,
Enzer I,
Cooper C,
et al.
(2000) GP job satisfaction in 1987, 1990 and 1998: lessons for the future? Fam Pract 17(5):364–371.
OpenUrl CrossRef PubMed

[137] Sibbald B,

[138] Enzer I,

[139] Cooper C,

[140] et al.

[141] 39.↵
Sibbald B,
Bojke C,
Gravelle H
(2003) National survey of job satisfaction and retirement intentions among general practitioners in England. BMJ 326(7379):22.
OpenUrl Abstract/FREE Full Text

[142] Sibbald B,

[143] Bojke C,

[144] Gravelle H

[145] 40.↵
Van Ham I,
Verhoeven AAH,
Groenier KH,
et al.
(2006) Job satisfaction among general practitioners: a systematic literature review. Eur J Gen Pract 12(4):174–180.
OpenUrl CrossRef PubMed

[146] Van Ham I,

[147] Verhoeven AAH,

[148] Groenier KH,

[149] et al.

[150] 41.↵
Griffeth RW,
Hom PW,
Gaertner S
(2000) A meta-analysis of antecedents and correlates of employee turnover: update, moderator tests, and research implications for the next millennium. J Manag 26(3):463–488.
OpenUrl CrossRef

[151] Griffeth RW,

[152] Hom PW,

[153] Gaertner S

[154] 42.↵
Buciuniene I,
Blazeviciene A,
Bliudziute E
(2005) Health care reform and job satisfaction of primary health care physicians in Lithuania. BMC Fam Pract 6(1):10.
OpenUrl CrossRef PubMed

[155] Buciuniene I,

[156] Blazeviciene A,

[157] Bliudziute E

[158] 43.↵
Dale J,
Potter R,
Owen K,
et al.
(2015) Retaining the general practitioner workforce in England: what matters to GPs? A cross-sectional study. BMC Fam Pract 16:140.
OpenUrl

[159] Dale J,

[160] Potter R,

[161] Owen K,

[162] et al.

[163] 44.↵
Groenewegen PP,
Hutten JB
(1991) Workload and job satisfaction among general practitioners: a review of the literature. Soc Sci Med 32(10):1111–1119.
OpenUrl CrossRef PubMed

[164] Groenewegen PP,

[165] Hutten JB

[166] 45.↵
O’Connor DB,
O’Connor R,
White B,
Bundred P
(2000) Job strain and ambulatory blood pressure in British general practitioners: a preliminary study. Psychol Health Med 5(3):241–250.
OpenUrl

[167] O’Connor DB,

[168] O’Connor R,

[169] White B,

[170] Bundred P

[171] 46.↵
Buchbinder SB,
Wilson M,
Melick CF,
Powe NR
(2001) Primary care physician job satisfaction and turnover. Am J Manag Care 7(7):701–713.
OpenUrl PubMed

[172] Buchbinder SB,

[173] Wilson M,

[174] Melick CF,

[175] Powe NR

[176] 47.↵
Doran N,
Fox F,
Rodham K,
et al.
(2016) Br J Gen Pract, Lost to the NHS: a mixed methods study of why GPs leave practice early in England. DOI: https://doi.org/10.3399/bjgp16X683425&#39.

[177] Doran N,

[178] Fox F,

[179] Rodham K,

[180] et al.

[181] 48.↵
Wordsworth S,
Skåtun D,
Scott A,
French F
(2004) Preferences for general practice jobs: a survey of principals and sessional GPs. Br J Gen Pract 54(507):740–746.
OpenUrl PubMed

[182] Wordsworth S,

[183] Skåtun D,

[184] Scott A,

[185] French F

[186] 49.↵
Humphreys J,
Jones J,
Jones M,
et al.
(2001) A critical review of rural medical workforce retention in Australia. Aust Health Rev 24(4):91–102.
OpenUrl PubMed

[187] Humphreys J,

[188] Jones J,

[189] Jones M,

[190] et al.

[191] 50.↵
Newton J,
Luce A,
Van Zwanenberg T,
Firth-Cozens J
(2004) Job dissatisfaction and early retirement: a qualitative study of general practitioners in the Northern Deanery. Prim Health Care Res Dev 5(1):68–76.
OpenUrl

[192] Newton J,

[193] Luce A,

[194] Van Zwanenberg T,

[195] Firth-Cozens J

[196] 51.↵
Centre for Workforce Intelligence
(2014) In-depth review of the general practitioner workforce (CfWI, London).

[197] Centre for Workforce Intelligence

[198] 52.↵
Evans J,
Goldacre MJ,
Lambert TW
(2000) Views of UK medical graduates about flexible and part-time working in medicine: a qualitative study. Med Educ 34(5):355–362.
OpenUrl CrossRef PubMed

[199] Evans J,

[200] Goldacre MJ,

[201] Lambert TW

[202] 53.↵
Feeley TH
(2003) Using the theory of reasoned action to model retention in rural primary care physicians. J Rural Health 19(3):245–251.
OpenUrl PubMed

[203] Feeley TH

[204] 54.↵
Matthews-King A
(Mar 2, 2016) Pulse, Education bosses launch landmark review into GP attitude in medical schools. http://www.pulsetoday.co.uk/your-practice/practice-topics/education/education-bosses-launch-landmark-review-into-gp-attitude-in-medical-schools/20031274.fullarticle (accessed 13 Feb 2017).

[205] Matthews-King A

[206] 55.↵
Wass V,
Gregory S,
Petty-Saphon K
(2016) By choice — not by chance: supporting medical students towards future careers in general practice (Medical Schools Council and Health Education England, London).

[207] Wass V,

[208] Gregory S,

[209] Petty-Saphon K

[210] 56.↵
Bradby H
(2014) International medical migration: a critical conceptual review of the global movements of doctors and nurses. Health (London) 18(6):580–596.
OpenUrl

[211] Bradby H

[212] 57.
Buchan J,
Dovlo D
(2004) International recruitment of health workers to the UK: a report for DFID: final report, Department for International Development Health Systems Resource Centre (DFID HSRC, London).

[213] Buchan J,

[214] Dovlo D

[215] 58.
Legido-Quigley H,
Saliba V,
McKee M
(2015) Exploring the experiences of EU qualified doctors working in the United Kingdom: a qualitative study. Health Policy 119(4):494–502.
OpenUrl

[216] Legido-Quigley H,

[217] Saliba V,

[218] McKee M

[219] 59.
Lozano M,
Meardi G,
Martín-Artiles A
(2015) International recruitment of health workers. British Lessons for Europe? Emerging concerns and future research recommendations. Int J Health Serv 45(2):306–319.
OpenUrl CrossRef PubMed

[220] Lozano M,

[221] Meardi G,

[222] Martín-Artiles A

[223] 60.↵
Young R,
Noble J,
Mahon A,
et al.
(2010) Evaluation of international recruitment of health professionals in England. J Health Serv Res Policy 15(4):195–203.
OpenUrl CrossRef PubMed

[224] Young R,

[225] Noble J,

[226] Mahon A,

[227] et al.

[228] 61.↵
Hemphill E,
Dunn S,
Barich H,
Infante R
(2007) Recruitment and retention of rural general practitioners: a marketing approach reveals new possibilities. Aust J Rural Health 15(6):360–367.
OpenUrl PubMed

[229] Hemphill E,

[230] Dunn S,

[231] Barich H,

[232] Infante R

[233] 62.↵
Stapleton G,
Schroder-Back P,
Brand H,
Townend D
(2014) Health inequalities and regional specific scarcity in primary care physicians: ethical issues and criteria. Int J Public Health 59(3):449–455.
OpenUrl

[234] Stapleton G,

[235] Schroder-Back P,

[236] Brand H,

[237] Townend D

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Addressing the crisis of GP recruitment and retention: a systematic review

Abstract

INTRODUCTION

METHOD

How this fits in

RESULTS

Recruitment in general practice

Retention of GPs

DISCUSSION

Summary

Strengths and limitations

Implications for research and practice

Acknowledgments

Appendix 1. Search terms

Appendix 2. Characteristics of included reviews on determinant of recruitment and retention of GPs

Notes

Funding

Ethical approval

Provenance

Competing interests

Discuss this article

REFERENCES

In this issue

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Main menu

User menu

Search

Addressing the crisis of GP recruitment and retention: a systematic review

Abstract

INTRODUCTION

METHOD

How this fits in

RESULTS

Recruitment in general practice

Retention of GPs

DISCUSSION

Summary

Strengths and limitations

Implications for research and practice

Acknowledgments

Appendix 1. Search terms

Appendix 2. Characteristics of included reviews on determinant of recruitment and retention of GPs

Notes

Funding

Ethical approval

Provenance

Competing interests

Discuss this article

REFERENCES

In this issue

Citation Manager Formats

Jump to section

Keywords

More in this TOC Section

Related Articles

Cited By...

NAVIGATE

RCGP

MY ACCOUNT

NEWS AND UPDATES

AUTHORS & REVIEWERS

CUSTOMER SERVICES

CONTRIBUTE

CONTACT US