High GP turnover linked to more A&E attendances, finds study

A high turnover of GPs has been linked to more A&E attendances by patients, with researchers highlighting a ‘desperate need to maximise retention’.

The analysis published today by a team of researchers at the University of Manchester found that ‘persistent high turnover’ – when more than 10% of GPs changed in a practice in at least three consecutive years – affected 2,309 practices in England (over 28%) between 2009 and 2019.

The study linked high turnover with more emergency hospital attendances, fewer people seeing their preferred GP and more people having lower satisfaction with their practice.

The researchers studied an average of 7,526 practices each year from 2007 to 2019 and observed a ‘worrying increase’ in the practices affected in a year, from 2.7% in 2009 to 6.3% in 2019.

The study also found that practices with persistent high turnover tended to be larger, located in more deprived areas and had a higher health burden from serious chronic conditions.

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.

According to the study, the highest levels of persistent high turnover were in Cumbria and the North East, South Central and the West Midlands.

The researchers said that the differences could be explained by different levels of social deprivation, unequal distribution of the GP workforce, and different pressures on the healthcare system.

Dr Rosa Parisi, a research fellow at the university and co-author of the study, said this was ‘a wakeup call for primary care’, giving clarity on the major problems affecting it.

She said: ‘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.’

Professor Evan Kontopantelis, professor of Data Science & Health Services Research and co-author, 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.’

Professor Azeem Majeed, professor of primary care and public health at Imperial College London, told Pulse that the findings of the study ‘confirm the importance of a stable primary care workforce.’

He said: ‘Practices with a higher turnover of staff will be less able to provide good continuity of care or work together effectively as a team.

‘There is debate about increasing the number of health professionals, including GPs, but we also need to implement measures to promote staff retention, for example, through improving the working conditions and well-being of primary care staff.’

Dr Kieran Sharrock, GPC England acting chair, told Pulse that the high turnover of GPs is ‘just another facet of the workforce crisis’ affecting general practice in England.

He said: ‘GPs are being encouraged to change their work patterns, reduce their hours, or retire entirely due to impossible workloads, unjustified negative rhetoric from politicians, and punitive pensions taxation rules and unfortunately the experience patients receive suffers accordingly.

‘Continuity of care is what patients want, what keeps people well, and what reduces health costs.

‘We know that patients benefit from continuity of care, with the quality, strength and consistency of their relationship with their family doctor having a significant impact on their health outcomes.

‘This was why the Health and Social Care Select Committee recently urged investment in continuity of care for all patients, with today’s report just providing more evidence for its urgency – especially for the more deprived parts of England.

‘It is therefore all the more essential that the Government reverse the loss of nearly 2,000 full-time equivalent GPs from the system since 2015 with a fully modelled workforce plan, address unrealistic workload pressures, and the end of punitive taxation rules.’

A Department of Health and Social Care spokesperson highlighted existing GP retention schemes, adding: ‘It is important everyone has access to appropriate medical care and we are hugely grateful for the hard work GP teams do – with over 70,000 more appointments currently available every working day compared to before the pandemic.

‘We are clear all registered patients must be assigned a named GP, and practices must try to accommodate requests from patients to see a particular GP.’

The RCGP last year highlighted failings in current GP retention schemes and called for them to be urgently overhauled.

It called for an additional £150m per year to be put towards the evaluation and expansion of both national and local GP retention schemes in England, with further funding for the devolved nations.

And it said this comes as the 19,000-strong mass exodus of GPs and GP trainees it warned about in June had risen to a potential 22,000.

Note: The headline was updated at 10.49 on 25 January to clarify that the study ‘linked’ high turnover with high A&E attendances. A previous headline mistakenly suggested high GP turnover ‘led to’ high A&E attendances.