A major review of UK evidence has found that sustaining the General Practitioner (GP) workforce depends on meaningful work, strong relationships, and cultures that support ongoing learning, all of which help deliver effective and equitable patient care.
General practice in the UK and worldwide is under pressure from GP shortages, high workload and falling job satisfaction. A lot of research into the causes for this focuses on individual-level factors such as wellbeing, resilience, and professional identity. However, researchers from the Nuffield Department of Primary Care Health Sciences have today published a new study which brings together evidence on how the way general practice services are organised affects both GP retention and patient care.
Published in the British Journal of General Practice, the researchers conducted a realist review – a type of study that looks at what works, for whom, and in what circumstances. They examined 191 UK-focused research papers and policy or practice reports published between 2013 and 2025. Patients and members of the public helped shape the questions and interpret the findings.
What the study found
The researchers discovered that three connected areas make the biggest difference to supporting GPs to stay in the role and provide safe and effective care:
1.Meaningful work and engagement
GPs are more engaged when their daily work aligns with their core values. They especially value direct doctor-patient interactions, relationship-based care and advocacy for patients and communities. Having time to talk, understand the wider context, and follow up with patients is key.
When paperwork, targets and constant triage crowd this out, work feels less meaningful and more stressful. Hidden admin, especially for patients the GP does not know, adds to the load.
2. Relationships and continuity across people, organisations and communities
Continuity and connection help GPs build cumulative knowledge about patients and their communities, making care safer and more personalised. Prioritising speed of access over relationships can disrupt this, which can hit people with complex needs or fewer resources hardest.
Working with other health professionals (such as clinical pharmacists or physician associates) can help, if there is time and support for supervision and clear communication. If not, GPs may carry indirect responsibility without adequate information or opportunities to share decisions with patients, increasing risk and reducing continuity.
3. Learning and developing together
Small, regular moments to connect with colleagues such as quick team ‘huddles’, mentoring, informal conversations, quality circles (small groups that meet to improve practice), all build trust and confidence for individuals and across practices.
A culture of psychological safety (where people feel able to ask questions and openly consider uncertainty) helps GPs make good decisions when problems are unclear or complex. Over-reliance on rigid protocols can undermine professional judgement in the undifferentiated, complex cases common in general practice.
Professor Sophie Park, from the Nuffield Department of Primary Care Health Sciences and lead author of the study, explains: ‘Our review shows that the challenges facing the GP workforce are not just about individual resilience or wellbeing, but rather the results of a broader design issue. What really matters is how general practice is organised. This needs to be planned in collaboration with users focusing on long-term goals and appropriately funded.’
She continued: ‘while technology and triage can help in places, they do not automatically make complex work easier or more efficient. Systems that prioritise GP-patient connection, safe delegation and team learning are more likely to keep GPs in post and deliver the kind of safe, personal care that patients value, especially for patients with multiple conditions or facing social disadvantage.’
Key recommendations from the review
Based on the findings, the researchers highlight five priorities for supporting both GP retention and good patient care:
- Protecting time for direct interactions and meaningful conversations between GPs, colleagues and patients is important to support care of people with complex problems and positively impacts GP wellbeing.
- Make continuity the default where possible by ensuring patients see a known GP or team, especially for ongoing or complex issues.
- Patient demand for appointments can be modified where GP and patient know each other and can pre-plan together.
- Use additional roles to complement, not replace, GP contact by planning proper supervision and ensuring patients still have direct access to a GP when needed.
- Changes in healthcare policy need to reduce not expand what is currently an unmanageable admin workload, allowing more time for tasks directly linked to patient care.
- Investing in team learning creates opportunities for peer support, mentoring, and shared reflection, all of which contribute to safer, more joined-up care.
This study is the first to explore how the way general practice services are organised affects GP workforce sustainability. It not only enhances our understanding of the factors that help GPs stay in the profession but also shows that the future of general practice depends on more than just individual resilience.
What does this study mean for today’s healthcare plans?
- Clinical care is about human interactions – while tech has a role supporting this, it cannot replace it.
- Demand is dynamic. If we can maximise opportunities to build human relationships between clinicians and patients, then we can minimise urgent/crisis demand.
- To sustain a GP workforce, work needs to be meaningful. This is key to decisions about supporting workload and requires long-term vision and mindful use of tech.
Creating the conditions for GPs to thrive means designing systems that value meaningful work, protect relationships, and foster ongoing learning. By acting on these principles, policymakers and practices can not only support GP retention but also ensure patients continue to receive safe, personal, and equitable care.
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Read the paper here: General practitioner workforce sustainability to maximise effective and equitable patient care: a realist review | British Journal of General Practice
This study/project is funded by the National Institute for Health and Care Research (NIHR) School for Primary Care Research (project reference 593).
The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.