Primary care

Morale among general practitioners: qualitative study exploring relations between partnership arrangements, personal style, and workload

Guro Huby, senior research fellow, ^a Marian Gerry, independent consultant, ^c Brian McKinstry, director of postgraduate medical educational research, SE Scotland, ^d Mike Porter, senior lecturer, ^b Johnstone Shaw, associate adviser in general practice, SE Scotland, ^d Robert Wrate, honorary senior lecturer. ^e

^a Working Minds Research/Department of Community Health Sciences, Primary Care Research Group, University of Edinburgh, 20 West Richmond Street, Edinburgh EH8 9DX, ^b Department of Community Health Sciences, General Practice, University of Edinburgh, ^c Family Business Facilitation, St Ragnvald's Street, Kirkwall, Orkney KW15 1PR, ^d Lister Institute, 11 Hill Square, Edinburgh EH8 9DR, ^e Department of Psychiatry, University of Edinburgh, Young People's Unit, Royal Edinburgh Hospital, Edinburgh EH10 5HF

Correspondence to: G Huby guro.huby{at}ed.ac.uk

Objectives: To explore general practitioners' experiences of wellbeing and distress at work, to identify their perceptions of the causes of and solutions to distress, and to draw out implications for improving morale in general practice.
Design: Three stage qualitative study consisting of one to one unstructured interviews, one to one guided interviews, and focus groups.
Setting: Fife, Lothian, and the Borders, South East Scotland.
Participants: 63 general practitioner principals.
Results: Morale of general practitioners was explained by the complex interrelations between factors. Three key factors were identified: workload, personal style, and practice arrangements. Workload was commonly identified as a cause of low morale, but partnership arrangements were also a key mediating variable between increasing workload and external changes in general practice on the one hand and individual responses to these changes on the other. Integrated interventions at personal, partnership, and practice levels were seen to make considerable contributions to improving morale. Effective partnerships helped individuals to manage workload, but increasing workload was also seen to take away time and opportunities for practices to manage change and to build supportive and effective working environments.
Conclusions: Solutions to the problem of low morale need integrated initiatives at individual, partnership, practice, and policy levels. Improving partnership arrangements is a key intervention, and rigorous action research is needed to evaluate different approaches.