What helps women GPs thrive?

General practice is often described through the language of pressure: rising demand, workforce shortages, burnout and retention challenges. Discussing the pressures is vital to making general practice sustainable, a central part of the NHS 10-year plan. But these pressures in primary care are often not experienced evenly.  

For women GPs, the pressures of general practice work often intersect with gendered expectations about care, communication, availability and career progression. Women now make up more than half of the GP workforce, yet evidence shows they continue to experience higher rates of burnout, anxiety and depression than men, alongside slower career progression and persistent gender pay gaps.  

Some of these inequalities are shaped by the everyday nature of clinical work. Women GPs are also often sought out by patients for particular types of care, including women’s health, mental health and more complex psychological concerns. This relational, patient-centred work can be deeply meaningful. Many women GPs describe the relationships they build with patients as one of the most rewarding aspects of general practice.  

But when this complex and emotionally demanding work is unevenly distributed, poorly recognised, or squeezed into systems that do not allow enough resource and time, the very parts of the job that bring satisfaction can also become sources of exhaustion, reduced career opportunities and burn out. In other words, the same gendered expectations that may make women GPs especially valued by patients can also make their work less visible, less sustainable and less fairly rewarded. 

Examining the evidence 

In a new review I’ve co-author, led by Dr Ruth Abrams at the University of Surrey and published in the British Journal of General Practice, we wanted to explore not only the pressures that face women GPs but understand what helps women in general practice thrive? 

Our review brought together evidence from 72 academic and grey literature documents across international primary care systems. We used a realist approach, which means we were interested not only in what happens, but in how, why, for whom and under what circumstances women GPs are best able to succeed. 

A central part of this approach was developing causal explanations through context–mechanism–outcome configurations. In simple terms, these configurations help us understand how particular conditions trigger particular responses, leading to particular outcomes. 

For example, when women GPs have high-quality, enriching interactions with patients and colleagues, this can strengthen their sense of meaningful work and contribute to job satisfaction. But when patients with complex needs disproportionately request women GPs, and when the additional emotional and clinical labour involved is not recognised, this can negatively affect wellbeing, career development and retention. 

We identified 16 context–mechanism–outcome configurations and grouped these into three areas: patient-facing work, navigating competing roles, and sustainable careers, leadership and success. 

What makes thriving possible & what undermines it?

Across these areas, we found that women GPs are more likely to thrive when they have supportive relationships with colleagues, access to supervision and mentoring, flexible working arrangements that are genuinely respected, visible role models, and career development opportunities that fit with the realities of their lives and work. These conditions matter because thriving is not only about avoiding burnout, it is also about learning, job satisfaction, a positive professional identity and a sustainable sense of career progression. 

We also found clear evidence of the conditions that undermine thriving. These include gender-based mistreatment from patients and colleagues, unequal distribution of complex patient work, expectations to take part in meetings or development opportunities outside contracted hours, and a lack of recognition for part-time working. For women with caring responsibilities, these pressures can be particularly acute. But it is also important to recognise that women GPs are not a single homogenous group. Experiences are shaped by additional inter-sectional factors such as race, ethnicity, disability, neurodivergence, health, career stage, and parental status.. 

One of the most striking findings from the review was how often the literature still frames the solution as something women GPs must do for themselves. Women are encouraged to work part-time, craft their jobs differently, seek mentoring, build resilience or find support networks. These strategies can be valuable, but they do not remove the wider organisational and structural conditions that create or sustain inequality in the first place. 

That matters because thriving should not depend on individual women finding ways to survive difficult systems. If we want to retain women GPs and support them to flourish, we need to look at the cultures, policies and everyday working practices of general practice. 

Changing the conditions of work 

Through discussion of our analysis with stakeholders and PPI, we have developed recommendations. These include practical changes within practices: recognising and redistributing complex emotional workload; protecting time for peer support; making routes for reporting gendered comments, harassment or unfair treatment visible and safe; scheduling meetings and development opportunities in carer-friendly hours; and ensuring that part-time GPs are included equitably in decision-making, leadership and career progression. 

But responsibility does not sit with practices alone. Training providers, professional bodies, regulators, policymakers, patients and the wider public also have a role to play. Supporting women GPs to thrive means challenging assumptions about who provides care, what kinds of care are valued, and what a successful GP career should look like. 

Our review also highlights important gaps in the evidence. We need more research into the experiences of women GPs from racial and ethnic minority backgrounds, and of women GPs who are disabled, neurodivergent or living with long-term health conditions. We also need to better understand how reproductive health - including menstruation, pregnancy, postnatal return to work and menopause - interacts with work, career progression and sustainability in general practice. 

Importantly, we also need to evaluate the initiatives that are intended to help. Mentoring, supervision groups, leadership programmes, coaching, peer networks and gender-specific professional development may all offer value, but we need stronger evidence about what works, for whom, and in what circumstances. We also need to be careful that these initiatives do not simply place more responsibility on women GPs to adapt to systems and cultures that remain unchanged. 

General practice depends on the expertise, commitment and compassion of its workforce. Women GPs bring enormous value to patients, teams and communities. But valuing that contribution means more than recognising individual dedication. It means creating the conditions in which women GPs can do meaningful work, progress in their careers, feel safe and supported, sustain fulfilling professional lives, and enjoy patient care. 

Our review shows that those conditions are possible. The next step is to make them routine. 

Read the full paper ‘Investigating the conditions in which women GPs thrive in General Practice: A realist review’ in the British Journal of General Practice. Accepted manuscript. DOI: https://doi.org/10.3399/BJGP.2025.0785