Belonging, autonomy and burnout: Why GPs leave

Today, we’re speaking to Dr Laura Jefferson, Senior Research Fellow based at the University of Manchester. We’re here to discuss her paper recently published here in the BJGP titled, ‘Understanding persistent GP turnover using work and personal characteristics: a retrospective observational study’.

Title of paper: Understanding persistent GP turnover using work and personal characteristics: a retrospective observational study

DOI: https://doi.org/10.3399/BJGP.2025.0260

GP turnover rates from national administrative datasets have previously been used to explore practice-level factors associated with turnover and its relationship to patient. outcomes. The individual and work characteristics associated with turnover is less well understood, with much research focusing on intentions to leave or smaller samples of GPs leaving practice. This study sought to fill this research gap, through analysis of a large dataset of GPs working experiences linked to turnover, understanding potential predictors that may offer solutions to the workforce crisis being faced in general practice. We find that GPs’ sense of autonomy, belonging and competence are significantly lower in practices with problems with persistent turnover and demonstrate how satisfaction with work characteristics such as working hours and experiences of strained relationships differs in practices with persistent turnover.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.880 - 00:00:53.050

Hello and welcome to BJGP Interviews. My name is Nada Khan and I'm one of the Associate editors of the bjgp. Thanks for joining us here to listen to this podcast today.

In today's episode, we're speaking to Dr. Laura Jefferson, who is a senior research fellow based at the University of Manchester.

We're here to discuss her paper, recently published here in the journal, titled Understanding Persistent GP Turnover Using Work and Personal A Retrospective Observational Study.

So, hi, Laura, it's really nice to see you again and to talk about this research and I suppose I really just wanted to frame our discussion here today by saying that there's been a lot of talk recently about the retention crisis in UK general practice, but I wonder, could you just talk us through how big is the scale of the problem that we're dealing with here?

Speaker B

00:00:53.370 - 00:02:12.110

Yeah, thank you. Yeah, well, thank you for inviting me to talk to you today as well.

I think it's interesting, we hear a lot of discussion in the media and in our research evidence as well, recently about an increase in GP turnover. In the past sort of decade, there's been a gradual increase, so that's in terms of GPs leaving medicine, but also moving across practices.

And it's good to see a kind of change in policy focus from historically, a lot of policies focused on recruitment of GPS. So, you know, we've had like, pledges to have 6,000 GPS that have not been met and it's often kind of criticized as filling a leaky bucket.

So if we try and obviously pay a lot. So I think it's approximately half a million pounds to train a gp, but actually to replace the GP is really expensive as well.

So it's about £300,000 to replace the GP.

And so, yeah, so there's a positive focus to thinking about retention, but actually it's about how can we do that effectively and understanding that the sort of one size fits all approach doesn't necessarily work and that there's different gps with different needs.

Speaker A

00:02:12.590 - 00:02:36.830

And this was a study where you were looking at the association between high practice turnover of GPs and GP job satisfaction. And what you did was you linked data from different general practice practices and GP workforce surveys.

But the first thing I wanted to really look into was that you identified these high turnover practices. What exactly did this mean?

Speaker B

00:02:37.070 - 00:04:33.190

Yeah, so there's been previous research that's done this before, so it's using. We're really fortunate in the UK that we've got really good workforce data compared to a lot of other countries.

So we have longitudinal data going back a long way that we can use for research purposes to try and understand more about these trends.

So colleagues of mine at Manchester have previously used this data from NHS Digital, which is now NHS England, linking with data on gps by General Practice, which is has got data on their kind of start and leave dates in a practice. And that allows us to track where gps are moving out of a practice and how long they've stayed there for.

So they've previously looked at sort of persistent turnover as being categorized as a practice where they have consistently, for three years running, had a 10% turnover of GPS. So this is where it seems to be a more worrying turnover figure.

I think it's expected that there's going to be some level of turnover and some level of turnover that might be a useful thing. But those kind of practices where you think, oh, what's going on there?

And particularly then within our research, looking at what are the striking differences in those practices, both in terms of the sort of workplace characteristics that GPs are experiencing? So can we use that data to explore strategies that could be used to actually support gps in those practices?

So trying to understand, really, what does it feel like for a GP in these practices with persistent turnover, so that then, hopefully, through this sort of research, is