Appendix 9Tables showing level of quitting and the main results/associations in each study

Publication Details

For each study, Tables 33–35 show (1) the overall level of intention to quit direct patient care (e.g. early retirement intention or intention to reduce hours) and (2) the potential factors explored in relation to that quitting construct.

TABLE 33

Factors associated with intention to fully quit from providing general practice care (UK studies)

TABLE 35

Factors associated with the intention to reduce hours, work part-time or take a career break (non-UK studies)

TABLE 34

Factors associated with intention to fully quit from providing general practice care (non-UK studies)

Publication Details

Copyright

Copyright © Queen’s Printer and Controller of HMSO 2019. This work was produced by Campbell et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

Publisher

NIHR Journals Library, Southampton (UK)

NLM Citation

Campbell JL, Fletcher E, Abel G, et al. 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 Apr. (Health Services and Delivery Research, No. 7.14.) Appendix 9, Tables showing level of quitting and the main results/associations in each study.

TABLE 33

Factors associated with intention to fully quit from providing general practice care (UK studies)

Study first author	Year of publication	Determinants/associations assessed (verbatim)	Level of retirement intention/hours reduction planned in all respondents	Text describing the relevant results/associations (or retirement intentions, etc., in subgroups)
Baker⁷⁷	2000	Gender, age (10-year age bands), principal/non-principal status, GP qualification cohort (1986, 1991, 1996)	64.1% would prefer to work fewer hours per week	50.7% wanted to retire aged 56–60 years
				23.8% of women would like to retire aged 51–55 years and 26.9% of men would like to retire aged 61–65 years
				Intended retirement age: see Table 24
Campbell¹⁷	2015	Age, gender, ethnic group, region graduated, position, practice deprivation, practice size, practice location	35% of GPs reported high risk of quitting direct patient care in next 5 years. 22% reported intention to take a career break in next 5 years	Intention to quit increased with age; significantly more men than women were intending to quit and more GP partners intending to quit
Chambers⁵⁴	2004	NS (probably only open question about reasons for intention to retire early)	54 (81%) intended to retire before the age of 60 years and 170 (51%) intended to retire at 60 years old	Of those intending to retire before 60 years of age, 55 (81%) ‘cited excessive workload as the reason’
Dale⁴⁴	2015	List of factors that might influence/reverse decision taken from recent media coverage and policy documents, plus free-text comments. Workplace influences and individual motivators	82% intend to leave GP work, take career break, reduce hours of work in next 5 years (41.9% intend to leave, 23.3% intend to take career break) 5.6% intend to increase hours	65.6% of men intend to leave within next 5 years; 64.3% of those aged 50–59 years intend to leave within 5 years, 84% of GP principals intend to leave within 5 years
				Greatest work influence: intensity of workload, volume of workload, time on unimportant tasks, 7-day working week, job satisfaction. Greatest individual motivators: changes to pension taxes and age
				Overall workload more important for GPs aged < 50 years and for GP principals. Working conditions more important to men than women and less important with increasing age. Work–life flexibility less important with increasing age and more important for women, personal development more important for women, GPs with > 10 years’ service and GP principals (see Table 2). Table 3 has summary of GP attributes associated with principal components linked to intention to leave within 5 years
French⁵⁷	2005	Inducement factors (implicitly, that would induce GPs ‘to consider working longer’ – that is, beyond their planned retirement age	Mean planned retirement age = 59 years (SD 5 years)	70% (49) of male GPs and 55% (121) of female GPs would consider working longer if they could do so on a part-time basis. From free-text comments: other possible inducements to work longer were financial need (30%), sufficient job satisfaction (19%), financial incentives (13%) and reduced/no on-call work (4%)
French⁵⁸	2006	Warr–Cook–Wall job satisfaction scale¹⁶⁷ (10 items) gender, whether or not spouse is doctor	Planned to retire at average ages of 59 years. Where women and men worked comparable hours, differences in job satisfaction disappeared	Women with greater job satisfaction = worked fewer hours. Males would delay retirement (57% compared with 44% of women) if they could work part-time with protected pension rights
French⁵⁸	2006			Men worked mean of 55 hours per week; women worked 42 hours per week (mean). Mean sessions per week: 10 for men and 7 for women. Mean number of hours in clinical work: 33 for men and 26 for women. 92% of men participate in out-of-hours work but 74% of women. Of those who wish to change sessions, 96% of men wished to reduce their hours compared with 80% of women
Gibson⁴³	2015	Age, gender, hours of work, contract type, practice size; job stressors on 14-item scale; job attributes on 15-item list; likelihood of retiring, increasing or reducing work hours, leaving in next 5 years; job satisfaction on 9-item Warr–Cook–Wall scale	35.34% of respondents indicated a considerable likelihood that they would quit patient care in next 5 years	Proportion expecting to quit increased from 8.9% in 2012 to 13.1% in 2015 among GPs aged < 50 years. Increased from 54.1% in 2012 to 60.9% in 2015 among GPs aged ≥ 50 years. Planned age of retirement for those aged ≥ 50 years is average 61 years, range of 51–75 years
			50.96% intending to reduce work hours in next 5 years	Table 15 shows the likelihood of intention to quit by gender and age
			41% have considerable/high intention to leave UK/leave patient care/leave medical work in next 5 years. 35.29% high likelihood of reducing work hours in next 5 years vs. 4.50% high likelihood of increasing work hours. (See Table 19.) Likelihood of changing working hours in next 5 years	Table 18 shows the likelihood of leaving patient care within 5 years by age group. 21% of GPs aged < 50 years and 63% of those aged ≥ 50 years have high intention to leave UK/leave patient care/leave medical work in next 5 years. GPs aged < 50 years – 25% who did not intend to leave did intend to reduce work hours in next 5 years. 44% of GPs aged ≥ 50 years did not intend to leave but did intend to reduce hours in next 5 years
Hutchins⁷⁶	2005	Whether or not plan to continue as principal after study leave; perceived benefits of study leave	Only one respondent planned not to continue as principal after study leave	Positive reassessment of work and career 23%; renewed enthusiasm for primary care 21%; enjoyment of learning and working 10%. 68% achieved new appointment as a result, with 60% undertaking committee or advisory roles in addition to clinical work. 17% developed medical specialist role, 11% academic training role while continuing as GP. 10% said that it had not been altogether positive taking study leave
Luce⁶¹	2002	12 factors influencing retirement decision (great, moderate or no influence); 14 factors influencing later retirement (before, at or after 60 years of age)	68.7% had made plans to retire, average planned age 59.2%; 34.6% planned early retirement (before 60 years); 49% planned to retire at 60 years; 15% between 61 and 65 years and 1.5% at 66 years or older. Ideally would retire almost 2 years before planned but 12.9% would ideally retire later than planned. 78.3% planned to undertake some work after retirement, 34.5% planned complete retirement	Women more likely to plan early retirement (46.2%) than men (32.1%); 23.7% of those over 55 years wanted to retire later than planned ideally (and 8.2% of those under 55 years). Higher psychological distress on General Health Questionnaire = planned to retire earlier
				Men more influenced to delay retirement by change in work role (62.8%), decreased clinical role (58.9%), opportunity to work peripatetically (24.4%), during term time only (22.4%). No specific factors for women
				Reducing clinical work seen as reason to delay retirement for GPs planning retirement before or at 60 years; increased pensions for later retirement and being encouraged to stay by partners more important for older GPs planning late retirement
Martin⁴¹ (The Health Foundation)	2015	Job satisfaction and stressors	30% plan to leave GP work in next 5 years	67% of UK GPs very satisfied or satisfied with practising medicine, compared with 79% average for GPs in other countries (was 84% of UK GPs in 2012 survey)
				59% of UK responders found practising ‘very stressful’ or ‘extremely stressful’, higher than any other country surveyed
				Of the 12% of GPs planning to switch careers or specialisms, 77% are under 55 years old. Of the 29% of GPs who intend to leave within 5 years, a third are under 55 and not planning to retire
				Figure 9 in Davis et al.¹⁶⁸ shows correlation between stress level and intention to leave
McKinstry⁴⁶	2006	Expectation of change in workload and number of sessions in next 2 years, retirement intentions	Overall doctors provide 7.4 clinical sessions a week and an additional 0.9 hours of NHS work, educational or research	‘Doctors over the age of 35 infrequently worked more than 5 sessions.’ Mean of 5.15 sessions per week of clinical work. Men 5.8 sessions, women 4.9 sessions per week
				22 respondents intended to retire in next 5 years (mainly men). 12 intended to leave owing to stress of job
				Women more likely to think commitment to GP work would increase in next 5 years (28.5% women, 19.2% men)
Simoens⁴²	2002	Job satisfaction with nine aspects of work (Warr–Cook–Wall scale); job stressors on 31-item scale; gender, age, ethnicity, hours worked per week, type of GP, household income, number of GPs in practice, practice location, level of deprivation	‘Around one-third’ intend to reduce working hours within 5 years	Intend to leave within 2 years – 11% GP principals, 38% non-principals, 14% PMS GPs
				Household income not associated with intention to quit
				PMS GPs = greater job satisfaction and lower intention to quit
				GP principals most likely to intend to leave within 5 years and PMS GPs least likely to intend to quit
				Male GPs more likely to intend to quit than female GPs. White GPs more likely to intend to quit than those from other ethnicity. GP principals who worked > 50 hours per week more likely to intend to quit than GPs who worked < 50 hours per week. GP non-principals in rural areas had higher intention to quit than those in urban areas
Taylor⁶⁴	1999	Practice size, gender, deprived areas, inner/outer London	13% left practice in their health authority within 2 years	Inner London, new entrant GPs retention rate was 82% compared with 89% outside London; 84% of women were retained compared with 90% of men
Taylor¹⁶⁹	2008	Job satisfaction	11.1% of male GPs work part-time compared with 53.8% of female GPs. 26.7% of GPs overall work part-time	Part-time doctors much more satisfied with their leisure time (see table 5) leisure satisfaction score 4.4 for full time and 6.7 for part-time (scale of 1–10)
French⁵⁸	2006	Warr–Cook–Wall job satisfaction scale,¹⁶⁷ (10 items) gender, whether or not spouse is doctor	Where women and men worked comparable hours, differences in job satisfaction disappeared	Women had greater job satisfaction if they worked fewer hours
French⁵⁸	2006			Men worked mean of 55 hours per week, women worked a mean 42 hours per week. Mean sessions per week: 10 for men and 7 for women. Mean hours in clinical work: 33 for men and 26 for women. 92% of men participate in out-of-hours work but 74% of women. Of those who wish to change sessions, 96% of men wished to reduce their hours compared with 80% of women
Young⁶⁶	2001	Importance of 12 job-related and 9 personal factors in prompting them to leave	Table 2 has detailed findings – job and personal factors by age and gender Overall, most important factors were workload, NHS changes, high patient expectations, retirement	Table 2
				Dissatisfaction with NHS changes was more important among older age groups as a trigger to early retirement
				Job related factors – partnership problems, lack of career development, lack of flexible working hours, more important for younger leavers
				Personal factors: family–work balance, geographical mobility, more important for younger leavers
				Gender differences – older women rated partnership problems as more important
		Age, gender		Younger women rated childcare responsibilities and partner moving jobs
				Younger men: job-related factors, NHS changes
				Only 7% said increased remuneration would make them return
				17% said needed greater flexibility and 11% change of family circumstances
				40% of younger leavers had not returned

: NS, not stated; SD, standard deviation.

TABLE 34

Factors associated with intention to fully quit from providing general practice care (non-UK studies)

Study First author (country)	Year	Determinants/associations assessed (verbatim)	Level of retirement intention/hours reduction planned in all respondents	Text describing the relevant results/associations (or retirement intentions, etc., in subgroups)
McComb⁶⁸ (New Zealand)	2006	Demographic (gender, age, life status, number of children, number of family members who are also GPs, practice ownership, income, hours worked)	12.2% intended to leave within 6 months	Self-employed GPs: 10% intended to leave within 6 months, 25% within 5 years
			12.2% intended to leave within 6 months	Locums: 18% within 6 months, 36% within 5 years
		Psychological (satisfaction with general practice and commitment to general practice) – scored with five-point Likert scale. Commitment scale had 18 questions, satisfaction scale had one item only	28.8% intended to leave within 5 years	Other: 17% within 6 months, 34% within 5 years
Dewa⁶⁷ (Canada)	2007	Professional dissatisfaction using five-point scale (Likert?); Burnout using nine items from MBI; age	Intention to retire within next 2 years (not reported for whole group)	Of those who were professionally dissatisfied: 24.4% of those aged 55–64 years intended to retire within 2 years 8.4% of those aged 45–54 years intended to retire within 2 years 5.3% of those aged < 45 years intended to retire within 2 years Of those who were professionally not dissatisfied: 11.0% of those aged 55–64 years intended to retire within 2 years 8.4% of those aged 45–54 years intended to retire within 2 years 5.3% of those aged < 45 years intended to retire within 2 years Differences between dissatisfied and not dissatisfied: all p < 0.0001
Brett²⁷ (Australia)	2007–8	Age, gender, nine options why leaving early, seven options that might encourage to stay	63% intend to work as GP until at least 65 years, 6% unsure when they will retire	75% of women GPs plan to work to age 65 years but only 59% of men; men more likely to intend to retire early. (NB women more satisfied with their work and working fewer hours but carry on working for longer)
Brett²⁷ (Australia)	2007–8		(i.e. 31% intending to retire before age 65 years)
Pit⁷² (Australia)	2011	Burnout and occupational health measures: MBI (9-item Emotional Exhaustion subscale only); single-item job satisfaction measure; 5-item version of Effort–Reward Imbalance Questionnaire; 3-item version of Work Ability Index; 6-item Kessler Psychological Distress Scale; global health question from SF-36	Mean age of intended retirement from direct patient care was 63.5 years (SD = 6.9 years); 47% intending to retire before 65 years	GPs with early retirement intentions = younger, worked average 8 hours more per week, more sleep problems, feel they do not get respect deserved at work, higher levels of burnout and distress, lower job satisfaction and perceived lifetime best work ability
				GPs with medium or high burnout scores had four times the odds of wanting to retire early (see table 2, p. 302)
				GPs reporting work-related sleep problems = 3 × increase in odds of early retirement intentions. Early retirement intentions increased with higher psychological distress scores and in those in fair/poor general health
				Presenteeism = 74% among those planning early retirement

: SD, standard deviation; SF-36, Short Form questionnaire-36 items.

TABLE 35

Factors associated with the intention to reduce hours, work part-time or take a career break (non-UK studies)

Study first author (country)	Year of publication	Determinants/associations assessed (verbatim)	Level of actual part-time working or hours reduction planned, in all respondents	Text describing the relevant results/associations (or reduction/part-time intentions in subgroups)
Woodward⁷⁵ (Canada)	1993 and 1999	Gender, spouse working full-time, child younger than 6 years, no children, spouse is physician, rural practice	In 1993 physicians would prefer to work 37 hours a week; in 1999 would prefer to work 34 hours per week. Actual hours worked did not change significantly	Of those who were professionally dissatisfied: 13.5% of those aged 55–64 years intended to reduce their clinic hours 13.5% of those aged 45–54 years intended to reduce their clinic hours 10.7% of those aged < 45 years intended to reduce their clinic hours Of those who were professionally not dissatisfied: 6.6% of those aged 55–64 years intended to reduce their clinic hours 7.0% of those aged 45–54 years intended to reduce their clinic hours 5.7% of those aged < 45 years intended to reduce their clinic hours Differences between dissatisfied and not dissatisfied: all p < 0.05
Dewa¹⁷⁰ (Canada)	2007	Professional dissatisfaction using five-point scale (Likert?); burnout using nine items from MBI; age	Not specified
Shrestha⁷³ (Australia)	2008	WLB satisfaction (Likert scale)	52.9% reported good WLB	GPs reporting poor WLB intend to reduce hours (OR 0.10, 95% CI 0.09 to 0.12; p < 0.001). However, this association not explained by lower job satisfaction. WLB alone explained 20% of the variation in intention to reduce hours
Norman⁶⁹ (Australia)	2010 and 2011	Age, gender, health, family circumstances, work satisfaction, work hours, whether or not they do on-call work, business relationship with practice, practice location, income, density of GPs, patient population	43% of 3377 GPs stated a desire to reduce hours in 2010 (wave 3 of MABEL survey). Of 1177 of those GPs who also had data in 2011 survey, 26.8% had successfully reduced their working hours by more than 5 hours. Of the 861 GPs unable to reduce their hours, 75.1% still had desire to reduce hours in 2011	Older GPs, females, those in less good health, less satisfied were more likely to want to reduce hours. GPs working > 60 hours per week more likely to want to reduce hours (six times more likely). GP partners more likely to want to reduce hours. Middle-aged male GPs had very strong desire to reduce hours
Norman⁶⁹ (Australia)	2010 and 2011			Ability to actually reduce hours was predicted by age, gender and number of hours currently worked. Middle-aged GPs around 50 years least likely to achieve desired reduction in hours. Female GPs more likely to reduce hours. GPs working longer hours more likely to successfully reduce hours
RNZCGP³⁹ (New Zealand)	2015	Gender, age, reasons for working part-time, urban and rural	Figure 12 has hours worked per week as GP: largest group works 31–40 hours per week (32.1%)	Gender: mean hours per week worked: men 38.7, women 30.1 (see figure 13). 65% of women worked part-time as GP and 31% of men. 70% of part-time GPs were female and 30% were male (see table 7)
				Age: longest hours worked by 25–29 years age band and 55–65 years age band (see figure 14). Females in all age bands worked fewer hours than males, especially in 35–44 years age band (see figure 15)
				Figure 16 has age profile by gender of responders working 20 hours or fewer per week – average age for women 46 years and for men 59 years
				53% cited family responsibilities as reason for working part-time – and 89% of these were female. Figure 19: 45% of females cited family as reason for part-time work; 46% of males cited personal choice
				Figure 20 shows family responsibilities of those working part-time for family reasons
				Figure 21: female respondents intended working hours in 5 years – those aged 35–39 years intend to increase hours (38%)
				Table 9: 25% of men have weekly after-hours work

: WLB, work–life balance.