Intended for healthcare professionals


Quarter of GPs want to quit, BMA survey shows

BMJ 2001; 323 doi: (Published 20 October 2001) Cite this as: BMJ 2001;323:887
  1. Zosia Kmietowicz
  1. London

    General practice is no longer the stable, lifelong career it once was, according to a survey showing that the level of disillusionment among GPs is so widespread that a quarter want to leave the profession and many more plan to retire sooner than they had anticipated.

    Results from the biggest consultation of UK GPs in a decade show that GPs (mainly from England) are more dissatisfied than ever with their working conditions. More than two thirds described their morale as either “fairly low” or “very low,” with most of them admitting it was worse than five years ago.

    Only a third of the 23521 GPs who completed a questionnaire (55% of those who had been sent one from the BMA's General Practitioners Committee (GPC) a month ago) said they would recommend a career in general practice to a newly qualified doctor or a medical student.

    With most GPs managing list sizes of between 1500 and 2500 patients, many simply cannot cope. More than 90% said they were being asked to do too much but felt undervalued at the same time. Long hours, work related stress, and the fact that they thought patients were getting a raw deal all added to the profession's dissatisfaction.

    More than a quarter of GPs said they were “very serious” or “fairly serious” about looking for a new career outside general practice, and whereas only a handful of GPs would have considered retiring before the age of 60 when they entered the profession, nearly half (46%) now planned to take early retirement.

    But despite their low morale GPs firmly believe in the NHS and would rather work for the NHS than the private sector if the conditions in the two sectors were comparable. More than half the doctors who replied to the survey said they believed patients received better care in general practice than they did five years ago, although hospital services had got worse. But half the respondents doubted whether the NHS could continue to provide a comprehensive service, even with substantial additional resources.

    “The message we got from the survey is pretty much what we were expecting—the results tell us the profession is in a perilous state of disenchantment,” said Peter Corpe, secretary of the GPC. “The survey demonstrates that there is a huge commitment to the NHS from GPs, but at the moment the health service is unsustainable.”

    Few GPs seem impressed by the government's plans for the future of the health service. Most of the respondents to the survey said that new policies were unlikely to improve patient care and they would probably make GPs' working lives more difficult. More than 90% said that government strategies would fail to attract sufficient numbers of additional doctors into general practice and that problems with recruiting all types of healthcare professionals would mean GPs' workload was likely to remain unchanged for at least the next five years.

    Mr Corpe added that with the anticipated level of exodus from the profession, services would inevitably suffer unless very dramatic action was taken to retain current GPs and increase recruitment.

    Eight out of 10 GPs agreed that the general medical services contract needs to be radically overhauled but that the new personal medical services (PMS) contract (an alternative contractual option agreed locally between the provider and the commissioner) is not the way forward. GPs are split over whether the PMS contract offers any real advantages, and most doubt that it will help solve the recruitment problems facing the profession.

    Although the government believes the PMS contract will serve GPs well in the future, few GPs agree. Most believe doctors with a PMS contract have no long term security in terms of retaining their jobs and securing their pension, and 75% want the GPC to be involved in negotiating PMS arrangements.

    “We wanted to show that the process we started for negotiating the new contract—and in particular the issue of resigning over negotiating rights—is vindicated and now we have information directly from GPs to show that it is,” said Mr Corpe.

    “GPs are dissatisfied with their current contracts, and we have to negotiate with confidence with the Department of Health to make general practice more attractive. GPs just want to be able to do the best job they can, and if we can get them longer consultations and smaller list sizes then maybe they will have the flexibility to do just that.”

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