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Increasing pay helpful but not enough to retain GPs, finds study

An increase in wages can influence job satisfaction but is not enough to retain GPs unless bureaucracy is reduced, a study has found.

GPs must be given more ‘autonomy’ to provide high-quality care and not be ‘restricted unnecessarily’, researchers recommended.

In a systematic review of articles exploring the relationships between wages, job satisfaction and retention for NHS staff including GPs, researchers found that increasing pay would ‘potentially’ increase satisfaction ‘and therefore retention’.

However, the 31 articles reviewed in January 2020 showed that an increase in pay alone was ‘unlikely to be sufficient’ to improve staff retention.

The researchers recommended that staff should be given ‘the necessary autonomy to provide high-quality patient care without being restricted unnecessarily’.

The study said: ‘Autonomy is thought to have a strong influence on job satisfaction, yet different roles and environments afford staff varying levels of independence and standardisation efforts may reduce autonomy.’

However, it concluded that ‘more research is needed’ to identify the role of autonomy and the ‘standardisation of care’ on retention. 

It comes as NHS England promised a review into GP bureaucracy as part of the 2020/21 GP contract, with a working group recently launched. 

It also comes as the BMA and the RCGP have both warned that bureaucracy that was eased due to Covid-19 should not be reinstated after the pandemic, and in July health secretary Matt Hancock seemed to heed the calls.

The researchers added that ‘increasing flexibility’ as well as targeted wage increased and the creation of ‘bespoke CPD regimes’ are also potential solutions to improve workforce retention.

The study, published in the BMJ Open, said: ‘We found a clear relationship between job satisfaction and retention, and by increasing pay you can potentially increase satisfaction and therefore retention in the NHS.

‘This review established the negative effect that poor pay has on job satisfaction, yet an increase in pay alone was not, however, seen to improve staff retention.’

It added that ‘poor staffing levels and increased workloads can contribute to reduced job satisfaction’. 

Satisfaction was also closely linked to the quality of care that NHS staff ‘felt they provided’, according to the study.

It said: ‘It is argued that the size of the workforce has not changed proportionally to the change in demand. The NHS suffers from staff shortages and this has resulted in significant staff pressures.’

Leicestershire GP Dr Grant Ingrams told Pulse ‘micro-management’ has made general practice ‘unrewarding’, with many GPs leaving the profession because they have a CQC visit or revalidation coming up.

He said: ‘Lots of people say “my next revalidation date is next year so I’m going to go a month before” because they don’t want to be put through the stress of it.’

Dr Ingrams added: ‘If you make a job enjoyable, you won’t have a problem with recruitment. If it’s not doable and not enjoyable, it doesn’t matter how much money you give GPs.’

St Albans GP partner, RCGP senior educator and former GP federation lead Dr Mike Smith added that GP workforce retention issues are ‘multi-factoral’.

He said: ‘I don’t think it’s going to be “right, we’re going to pay you better and you’ve got complete autonomy” and therefore everything is fixed. It’s so much more complex than that.’

Dr Smith told Pulse there is ‘a lack of joy in the workplace’ – partly down to GPs having less professional interactions and partly down to a ‘relentless’ and ‘ever-increasing workload’.

He said: ‘I don’t mean necessarily the paperwork, I mean the patient expectations, how we’re expected to treat them, the increased range of treatments [and services] available to people. 

‘That becomes very daunting. I’ve really been reflecting in the last couple of weeks thinking something needs to change because I can’t do this for the next 10-20 years.’

It comes as last week, it was revealed that the number of fully-qualified, full-time-equivalent GPs working in England is continuing to fall – dropping by 651 from June 2019 to June 2020. 

Meanwhile, the BMA is set to vote on industrial action concerning doctor pay at this year’s ARM, and the BMA’s GP Committee previously warned the Government that GPs were ‘incensed’ at the unequal pay uplift they were awarded this year.

NHS England’s People Plan, published in July, said building on the ‘flexible working changes’ brought about by Covid-19 would be ‘crucial’ for retaining staff across the NHS.

NHS England also outlined plans for locum GPs to be offered ‘highly flexible’ salaried roles in a bid to bring them into the substantive GP workforce.

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