Study shows impact of high GP turnover on service and health

A new study by University of Manchester researchers has revealed the stark impact that high turnover of GPs has on patients’ health outcomes and the service they receive in England.

The analysis found that ‘persistent high turnover’, defined by the researchers as when more than 10% of GPs changed in a practice in at least 3 consecutive years - was not uncommon.

Persistent high turnover affected 2,309 of English practices (over 28%) at least once between 2009 and 2019.

The practices were associated with:

• 1.8 more emergency hospital attendances per 100 patients.
• 5.2% fewer people seeing their preferred doctor.
• 10.6% fewer people reporting obtaining an appointment on the same day.
• 1.3% more people having lower overall satisfaction with their practice.

Practices with ’persistent high turnover’ also 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.

Published in the journal BMJ Quality and Safety today (24/01/23), 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.

“Thanks to this work, it is now possible to identify an association between high turnover and both patients’ health outcomes and the service they receive.

“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.

“And the link between high turnover and deprivation may be explained by the challenges GPs face in those areas in managing patients with more complex health needs with no additional resources.”

The study also involved two discussion groups with a total of 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: “This study shows practices with persistent high GP turnover need more support from local and national authorities.

“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.

“We already know that socioeconomic deprivation impacts GP work found that in highly deprived areas, GP work typically extends beyond the management of the illness but that they are not resourced to perform those additional tasks.”

The  paper Predictors and population health outcomes of persistent high GP turnover in English general practices: a retrospective observational study is available here