Recruitment and retention of staff in rural dispensing practice (RETAIN)

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

1C.6

Presenter:

Rosina Cross

Twitter:

@RosinaACross

Co-authors:

Sinead TJ McDonagh, Emma Cockcroft, Malcolm Turner, Matthew Isom, Robert Lambourn, John L Campbell, Christopher E Clark

Author institutions:

University of Exeter, Dispensing Doctors’ Association Limited, @Cheviot Primary Care Centre

Problem

General Practice (GP) surgeries in rural areas often struggle to employ and retain healthcare professionals and other members of the multidisciplinary primary care team. Existing research into the problems of rural recruitment and retention is limited, and doctor focused. Migration of younger people from rural areas, high employment rates and absence of rural proofing in workforce planning may be important. A persistent shortage of appropriately qualified rural staff may affect functioning of the practice, quality of care and patient experience. Dispensing medications in rural practice is a service valued by patients, and some practices rely on the income generated from dispensing. However, little is known about how maintaining dispensing services contributes to recruitment and retention of staff.This study aims to understand the barriers and facilitators to working and remaining in rural dispensing practices, and to explore how the primary care teams value dispensing services.

Approach

We undertook semi-structured interviews with multidisciplinary team members of rural dispensing practices across England. Interviews were audio-recorded, transcribed and anonymised. Framework analysis is being conducted using Nvivo 12. Full findings will be presented at the conference.

Findings

Seventeen primary care staff members were recruited from 12 rural dispensing practices across seven regions in England. Four GPs, two practice nurses, five practice managers, two administrative staff and four dispensers were interviewed, with some of these individuals employed in multiple roles. Practice patient population size ranged from 2,500 to 26,000.Several interconnected factors impacting both recruitment and retention of staff to rural dispensing practice have been identified. Personal and professional reasons for taking up a role in a rural dispensing practice included perceived career autonomy and development opportunities, and preference for working and living in a rural setting. Challenges to recruitment were largely dominated by factors associated with non-clinical roles, but also to nursing roles, and concerns around staff access to care. The skilled nature of the dispensing role, teamed with the relatively low wages and high cost of living in, or commuting to, a rural area seemed to be a key barrier to recruitment in these roles. However, difficulties recruiting nurses seemed to stem from a perceived lack of knowledge around the nursing role in rural care.Key factors impacting retention of staff included revenue generated by dispensing, opportunities for staff development, job satisfaction and the positive work environment. Perceived challenges to retention were balancing the required skillset of dispensing with the wages available for the role, lack of skilled job applicants, negative perceptions of rural primary care practice and travel difficulties.

Consequences

The findings from this study can inform national policy and practice with the aim of improving the understanding of the challenges of working in rural dispensing primary care in England.

Submitted by:

Sinead McDonagh

Funding acknowledgement:

The RETAIN project was funded by the National Centre for Rural Health and Care (NCRHC). The views expressed are those of the authors and not necessarily those of the NCRHC, NIHR, the NHS or the Department of Health.