As Ireland works to strengthen and expand its primary care system in response to growing patient demand and increasing complexity, researchers in RCSI’s Graduate School of Healthcare Management are exploring the challenges faced by general practitioners with the goal of supporting improved retention.
Here, Dr Niamh Humphries, Senior Lecturer and Head of Research in the Graduate School of Healthcare Management, outlines what their novel study has found.
Health workforce planning is about having the right people with the right skills available to deliver care when and where it’s needed. This is a complex process that involves training and retaining enough staff to meet demand. Since the pandemic, there has been wider recognition of the need to strengthen the workforce and support health worker well-being.
Many doctors now seek more flexible work and training options as work‑life balance becomes increasingly important. While often linked to the rising number of women in medicine, research suggests that interest in flexibility reflects a broader generational shift toward more sustainable ways of working.
For most of us as patients, the general practitioner (GP) is the first doctor we turn to – the person who listens to our concerns, assesses what’s going on and provides or guide us towards the care we need. In Ireland, the role of our GPs has changed significantly in recent decades, with heavy workloads and high work intensity, long working hours and a heavy burden of administrative work.
Fewer GPs now practise in single-handed practices with many GPs opting to work in larger group practices. The profile of the GP workforce has also changed, and more than half of Ireland’s GP workforce is female (52%).
Managing workloads
I led the study team for the GP Retention project, which aimed to strengthen our understanding of GP work patterns, particularly in relation to their everyday ways of working and how they have modified their working hours and work commitments to achieve balance.
We used an innovative method of remote ethnography called 'mobile instant messaging ethnography' to connect with 20 GPs across Ireland. We conducted two online interviews with each GP alongside an eight-week discussion via an instant messaging app. This approach allowed us to gain a deeper understanding of the life of a GP in Ireland today.
Some of the GPs reported to us that they have reduced the number of patient consultations they are available for, as a way of managing their workload. They are doing this, not because they dislike practising as a GP, but rather to reduce the work intensity they were experiencing. They explained how fewer working hours reduced the intensity of their working week and helped them to achieve work-life balance and reduce their stress levels.
They also describe using job crafting to design more sustainable ways of working for themselves. As participants designed their portfolio careers, they sought to balance the intensity of GP work with other, less intensive work.
Several participants explained that they had done this to enable them to continue working as a GP until retirement age. Another participant reduced their sessions instead of quitting GP practice entirely.
The need for improved policies
All of this is a concern because national GP workforce projections predict the need for a significant increase in GPs by 2040 (24-31%). A reduction in the number of consultations undertaken by GPs would require a further increase in the number of GPs across the country.
These findings highlight the importance of improved data collection on the GP workforce and GP ways of working in informing more accurate planning and to ensure a strong GP workforce into the future.
As this project concludes, we’ve developed an animation which draws on our research findings to highlight the need for improved policies to support the retention and well-being of Ireland’s GPs.
The GP Retention Project (APA 2022 008) was funded by a HRB Applied Partnership Award with the Irish College of GPs as knowledge users. The full paper can be read here.
Dr Niamh Humphries is a Senior Lecturer and Research and Impact Lead at the RCSI Graduate School of Healthcare Management. She has been researching and seeking solutions to Ireland’s health workforce challenges for almost two decades.
RCSI is committed to achieving a better and more sustainable future through the UN Sustainable Development Goals.
