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Table 4 Policies and strategies deemed of ‘uncertain’ value after accounting for panel consensus

From: Identifying policies and strategies for general practitioner retention in direct patient care in the United Kingdom: a RAND/UCLA appropriateness method panel study

ID

Policy and strategy assessed by panellists

Median

 

For implementation at national/ regional level (n = 14)

 

25

In order to assess ‘at-risk’ status in a commissioning/planning area and taking into account confidentiality, GPs should be required to provide ‘intention to quit’ information regularly to assess areas ‘at-risk’.

3

26

In order to assess ‘at-risk’ status in a commissioning/planning area and taking into account confidentiality, GPs should be required to complete job satisfaction surveys (or equivalents) regularly to assess areas ‘at-risk’.

4.5

27

In order to assess ‘at-risk’ status in a commissioning/planning area and taking into account confidentiality, GP practices should be required to register their organisation’s at-risk status.

5

28

In order to assess ‘at-risk’ status in a commissioning/planning area and taking into account confidentiality: there should be regular audits to identify GP practices ‘at-risk’.

8 a

29

GP practices identified as being ‘at-risk’ should be targeted with additional support and incentives.

7.5 b

30

GP practices identified as being ‘at-risk’ should be prioritised for new/innovative national schemes to support GP retention and/or return to work.

7 b

5

GP practices identified as being ‘at-risk’ should be managed with an appropriate and sensitive supportive arrangement – for (i) compulsory implementation.

3 a b

6

GP practices identified as being ‘at-risk’ should be allocated a specialist team for managing recruitment and retention – for (i) compulsory implementation.

4.5 a

31

New arrangements should be developed so that GPs can become more involved in GP practice management without being partners.

5.5

32

New business models should be developed for GPs who wish to provide care within the NHS but prefer not to own a GP practice.

5

33

There should be incentive and support packages for not-for-profit organisations employing GPs to work across GP practices.

5

34

Hospitals should be permitted to open GP practices with registered lists – for (i) all areas, or (ii) operating in traditionally “hard to recruit” settings.

4, 5.5 b

35

There should be a publicity campaign highlighting the experiences of GPs who have successfully been retained in direct patient care as part of a marketing-based intervention aimed at GPs.

4.5

36

The positive experiences of GPs who are providing direct patient care should be consistently shared in a number of ways such as blogs and articles as part of a marketing-based intervention aimed at GPs.

5

 

For implementation at GP practice level (n = 12)

 

7

GPs who are returning to work after a period of absence or after a career break should have access to ‘Health and Wellbeing programmes’ to help them manage their re-entry into the workforce – for (i) compulsory implementation.

4.5 a

11

Peer support initiatives should be made available to GPs aimed specifically at health and well-being - for (i) all GPs or (ii) GPs reaching retirement and who could take their pensions.

9, 8.5 a b

37

GP practices should have systems in place to accommodate flexible ways of working.

7 b

38

GP practices should be able to demonstrate commitment to flexible ways of working through written human resources policies, guidelines or equivalents.

5

39

Human resources management support should be available to GP practices who are actively supporting GPs in combining other career interests with direct patient care.

7 b

40

GP practices should receive guidance on recommended approaches to supporting the staged exit of GPs who are looking to leave direct patient care.

7 b

41

GP practices should receive a toolkit on recommended approaches to supporting the staged exit of GPs who are looking to leave direct patient care.

5.5

42

Human resources responsibilities should be carried out externally to the employer/practice with responsibility for ongoing monitoring of how many GPs within an area have requested and successfully implemented flexible working arrangements – for (i) all GP practices, or (ii) GP practices operating in traditionally “hard to recruit” settings.

2.5, 5 a b

43

Human resources responsibilities should be carried out externally to the employer/practice with responsibility for managing flexible working arrangements for GPs – for (i) all GP practices, or (ii) GP practices operating in traditionally “hard to recruit” settings.

2.5, 5 a b

44

Human resources responsibilities should be carried out externally to the employer/practice with responsibility for all activities associated with retention of GPs – for (i) all GP practices, or (ii) GP practices operating in traditionally “hard to recruit” settings.

3, 5 a b

45

Human resources responsibilities should be carried out externally to the employer/practice with responsibility for all activities associated with professional development and training – for (i) all GP practices, or (ii) GP practices operating in traditionally “hard to recruit” settings.

2, 3 a b

46

Human resources responsibilities should be carried out externally to the employer/practice with responsibility for implementing standards for working hours and conditions – for (i) all GP practices, or (ii) GP practices operating in traditionally “hard to recruit” settings.

5, 5 a

 

For implementation at GP level (n = 12)

 

47

GPs should have access to their own specialised health care service to ensure a quick and confidential general health service – for (i) all GPs, (ii) GPs reaching retirement and who could take their pensions, or (iii) GPs not reaching retirement.

5.5, 5.5, 5.5 a

13

A structured programme of training and support should be made available to all GPs in their first 5 years following qualification as an independent GP to help them establish healthy, productive careers – for (i) compulsory implementation.

3 a

48

GPs should receive business management training and opportunities as a component of updating their skillsets - for (i) all GPs, (ii) GPs reaching retirement and who could take their pensions, or (iii) GPs not reaching retirement.

6, 5, 6 a

49

Clinical mentorship should be available to GPs as part of a nationally managed scheme - for (i) all GPs, (ii) GPs reaching retirement and who could take their pensions, or (iii) GPs not reaching retirement.

6.5, 6, 6 a

15

Career support should be available to GPs to enable portfolio opportunities to be identified and taken up in a strategic way to inform their future ambitions – for (i) GPs reaching retirement age and could take pensions

7 a b

50

Incentives and support packages should be available for those GPs developing portfolio careers who are making a substantial contribution to direct patient care service - for (i) all GPs, (ii) GPs reaching retirement and who could take their pensions, or (iii) GPs not reaching retirement.

7, 8, 7 a b

17

Where a strong case can be made that there is a financial risk directly relating to the work of the practice (e.g. ownership of premises), GPs should have access to schemes to reduce financial burden (e.g. buy back schemes for premises) – for (i) GPs not reaching retirement.

7 a b

51

GPs should be expected to include regular supervision/mentoring sessions as part of their normal professional activity - for (i) all GPs, (ii) GPs reaching retirement and who could take their pensions, or (iii) GPs not reaching retirement.

6, 5.5, 6 a

 

Specifically regarding GPs who are reaching retirement and who could take their pensions on exit

 

24

The annual appraisal and revalidation process for such GPs should be reviewed with a view to streamlining and simplifying the process – for (i) all GPs

5 a

52

Such GPs should be eligible for and offered support to facilitate direct patient care including additional dedicated administrative support.

6

53

Such GPs should be eligible for and offered support to facilitate direct patient care including medical assistants and other equivalent roles.

7 a b

54

Planned exits for such GPs should include pairing them in job share scheme with – (i) GPs returning to practice, or (ii) newly qualified GPs.

5, 6 a

  1. aThe median panel scores are presented are for the sub-groups presented in italics at the end of each policy and strategy area
  2. bIt is possible for a median score to fall within the ‘appropriate’ range (7–9) or ‘inappropriate’ range (1–3), but the statement to be of uncertain value as the panel failed to reach consensus (i.e. > 2 panellists provided a rating within the required range)