{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T13:25:57Z","timestamp":1793798757103,"version":"4.6.1"},"reference-count":18,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2020,5,12]],"date-time":"2020-05-12T00:00:00Z","timestamp":1589241600000},"content-version":"unspecified","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Health Research (NIHR) Health Service and Delivery Research (HS&DR) programme","award":["14\/196\/02"],"award-info":[{"award-number":["14\/196\/02"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,1,31]]},"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>UK general practitioners (GPs) are leaving direct patient care in significant numbers. We undertook a systematic review of qualitative research to identify factors affecting GPs\u2019 leaving behaviour in the workforce as part of a wider mixed methods study (ReGROUP).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To identify factors that affect GPs\u2019 decisions to leave direct patient care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Qualitative interview-based studies were identified and their quality was assessed. A thematic analysis was performed and an explanatory model was constructed providing an overview of factors affecting UK GPs. Non-UK studies were considered separately.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Six UK interview-based studies and one Australian interview-based study were identified. Three central dynamics that are key to understanding UK GP leaving behaviour were identified: factors associated with low job satisfaction, high job satisfaction and those linked to the doctor\u2013patient relationship. The importance of contextual influence on job satisfaction emerged. GPs with high job satisfaction described feeling supported by good practice relationships, while GPs with poor job satisfaction described feeling overworked and unsupported with negatively impacted doctor\u2013patient relationships.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Many GPs report that job satisfaction directly relates to the quality of the doctor\u2013patient relationship. Combined with changing relationships with patients and interfaces with secondary care, and the gradual sense of loss of autonomy within the workplace, many GPs report a reduction in job satisfaction. Once job satisfaction has become negatively impacted, the combined pressure of increased patient demand and workload, together with other stress factors, has left many feeling unsupported and vulnerable to burn-out and ill health, and ultimately to the decision to leave general practice.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-029846","type":"journal-article","created":{"date-parts":[[2020,5,13]],"date-time":"2020-05-13T05:45:25Z","timestamp":1589348725000},"page":"e029846","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":53,"title":["Understanding why primary care doctors leave direct patient care: a systematic review of qualitative research"],"prefix":"10.1136","volume":"10","author":[{"given":"Linda","family":"Long","sequence":"first","affiliation":[{"name":"ESMI (Evidence Synthesis & Modelling for Health Improvement), University of Exeter Medical School, Exeter, Devon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren","family":"Moore","sequence":"additional","affiliation":[{"name":"Graduate School of Education, University of Exeter, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Robinson","sequence":"additional","affiliation":[{"name":"ESMI (Evidence Synthesis & Modelling for Health Improvement), University of Exeter Medical School, Exeter, Devon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Sansom","sequence":"additional","affiliation":[{"name":"Primary Care Research Group, University of Exeter Medical School, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Aylward","sequence":"additional","affiliation":[{"name":"Patient and Public Involvement Group, PenCLAHRC, University of Exeter Medical School, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1319-3051","authenticated-orcid":false,"given":"Emily","family":"Fletcher","sequence":"additional","affiliation":[{"name":"Primary Care Research Group, University of Exeter Medical School, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8877-3926","authenticated-orcid":false,"given":"Jo","family":"Welsman","sequence":"additional","affiliation":[{"name":"Children's Health and Exercise Research Centre, University of Exeter, Exeter, Devon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3682-5149","authenticated-orcid":false,"given":"Sarah Gerard","family":"Dean","sequence":"additional","affiliation":[{"name":"PenCLAHRC, University of Exeter Medical School, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John L","family":"Campbell","sequence":"additional","affiliation":[{"name":"Primary Care Research Group, University of Exeter Medical School, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob","family":"Anderson","sequence":"additional","affiliation":[{"name":"ESMI (Evidence Synthesis & Modelling for Health Improvement), University of Exeter Medical School, Exeter, Devon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,5,12]]},"reference":[{"key":"2025101813032690000_10.5.e029846.1","doi-asserted-by":"crossref","unstructured":"Campbell JL , Fletcher E , et al, Health Services and Delivery Research . Policies and strategies to retain and support the return of experienced GPs in direct patient care: the ReGROUP mixed-methods study. Southampton UK: NIHR Journals Library, 2019.","DOI":"10.3310\/hsdr07140"},{"key":"2025101813032690000_10.5.e029846.2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-026048"},{"key":"2025101813032690000_10.5.e029846.3","unstructured":"Martin S , Davies E , Gershlick B . Under pressure: What the Commonwealth Fund\u2019s 2015 international survey of general practitioners means for the UK. London: The Health Foundation, 2016."},{"key":"2025101813032690000_10.5.e029846.4","doi-asserted-by":"crossref","DOI":"10.1186\/s12875-015-0363-1","article-title":"Retaining the general practitioner workforce in England: what matters to GPs? A cross-sectional study","volume":"16","author":"Dale","year":"2015","journal-title":"BMC Fam Pract"},{"key":"2025101813032690000_10.5.e029846.5","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-015853"},{"key":"2025101813032690000_10.5.e029846.6","unstructured":"Gibson J , Checkland K , Coleman A , et al . Eighth national GP Worklife survey UK, 2015."},{"key":"2025101813032690000_10.5.e029846.7","first-page":"1","article-title":"Primary care providers' views of recent trends in health care delivery and payment. Findings from the Commonwealth Fund\/Kaiser family Foundation 2015 national survey of primary care providers","volume":"24","year":"2015","journal-title":"Issue Brief"},{"key":"2025101813032690000_10.5.e029846.8","unstructured":"UoEMS, PCRG . The changing general practitioner workforce: the development of policies and strategies aimed at retaining experienced GPs and those taking a career break in direct patient care: ReGROUP project, 2016."},{"key":"2025101813032690000_10.5.e029846.9","doi-asserted-by":"publisher","DOI":"10.1332\/0305573042009444"},{"key":"2025101813032690000_10.5.e029846.10","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-8-45"},{"key":"2025101813032690000_10.5.e029846.11","unstructured":"Campbell J , Calitri R , Sansom A . Retaining the experienced GP workforce in Direct Patient Care(ReGROUP)- Final Report for the South West AHSN. Exeter, 2015."},{"key":"2025101813032690000_10.5.e029846.12","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-010592"},{"key":"2025101813032690000_10.5.e029846.13","unstructured":"NVivo qualitative data analysis software 11 2015."},{"key":"2025101813032690000_10.5.e029846.14","first-page":"367","article-title":"Influences on GPs' early retirement, and how to keep them","volume":"11","author":"Hutchins","year":"2005","journal-title":"British Journal of Health Care Management"},{"key":"2025101813032690000_10.5.e029846.15","doi-asserted-by":"crossref","unstructured":"Newton J . Job dissatisfaction and early retirement : a qualitative study of general practitioners in the Northern Deanery, 2004.","DOI":"10.1191\/1463423604pc191oa"},{"key":"2025101813032690000_10.5.e029846.16","unstructured":"Ipsos M . Looking to the future: the recruitment, retention and return of GPs summary and next steps report for NHS England. London: Ipsos MORI Social Research Institute, 2015."},{"key":"2025101813032690000_10.5.e029846.17","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp16X683425"},{"key":"2025101813032690000_10.5.e029846.18","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2296-15-154","article-title":"Are \"part-time\" general practitioners workforce idlers or committed professionals?","volume":"15","author":"Dwan","year":"2014","journal-title":"BMC Fam Pract"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2019-029846","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T20:03:37Z","timestamp":1760817817000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2019-029846"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5]]},"references-count":18,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,5,12]]},"published-print":{"date-parts":[[2020,5]]}},"alternative-id":["10.1136\/bmjopen-2019-029846"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2019-029846","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5]]}}}