Strategies to recruit and retain general practitioners: a systematic review

Conference: 
SAPC ASM 2015 - Oxford - Evidence and innovation in primary care
Talk Code: 
1C.6

The problem

GP recruitment is in crisis: too few doctors are entering full time general practice and increasing numbers are leaving. RCGP figures estimate that 8000 more GPs are needed by 2020. Numerous policies have attempted to increase recruitment and retention of GPs but there is little research evaluating what works.

The approach

The study systematically reviewed the effectiveness of interventions aimed at recruitment and retention of GPs. All study designs in high income countries were included. Studies into other health professionals were excluded. Outcome measures were number of doctors recruited and retained.Electronic searches were conducted to January 2015 in Medline, Embase and CENTRAL. Grey literature (OpenSigle, Kings Fund, internet search engines and specific international websites) the reference lists of included studies were also searched.All titles and abstracts were screened. Data were extracted and then double checked by the second researcher. The risk of bias and quality of the studies were assessed by a modified Newcastle Ottawa Scale.

Findings

3597 titles were identified (2835 after removal of duplicates). 184 underwent full text review. 51 articles, assessing 42 interventions, met the inclusion criteria. Four of these were unpublished. Most studies were cross sectional or case studies and of low quality. Interventions were categorised into thirteen groups.Financial incentives were generally successful, particularly if they tied the trainee into a lengthy service obligation. The modern GP retainer scheme which combines a service commitment and an educational element appeared to be successful but had limited impact in terms of numbers. Continued professional development opportunities and peer support were generally associated with higher levels of retention. Case managers or specialised recruiters aided in the recruitment of doctors in particularly underserved areas, but data on retention were not available. Recruitment of rural students was associated with higher rates of return to rural areas for practice. Delayed partnership for GPs in training schemes had a positive effect on retaining GPs in practice.Undergraduate and postgraduate placements in rural areas had mixed effects on retaining doctors in rural areas. It was difficult to assess the effectiveness of marketing strategies, one of which had a negative impact on recruitment. International recruitment incentives showed limited success of long term retention. A re-entry/ refresher course had some success at returning GPs to practice.Mixed financial, continued medical education and support incentives were poorly evaluated.

Consequences

This is the first systematic review to look at interventions to improve recruitment and retention of GPs. As primary care drives to recruit more GPs, several strategies have been identified which have the potential to improve numbers. Innovative solutions, such as case managers, financial incentives and better peer support, should be considered. Future initiatives to increase recruitment and retention should be rigorously evaluated.

Credits

  • Puja Verma, NHS Tower Hamlets CCG, London, UK
  • Nicholas Steel, NHS Tower Hamlets CCG, London, UK
  • Arabella Stuart, NHS Tower Hamlets CCG, London, UK
  • Amanda Howe, NHS Tower Hamlets CCG, London, UK
  • Sam Everington
  • John Ford, NHS Tower Hamlets CCG, London, UK