Evaluation of the GP Super Clinics Program 2007-2008

6.7 Recruiting and Retaining the Primary Care Workforce

Page last updated: 2012

Net Increase in Access to GPs in Local Areas

To date across these seven GP Super Clinics, it is estimated that there has been a net increase of 19 GPs. This figure is derived from the total number of GPs at each of the GP Super Clinics, minus the number of GPs reported by the Directors as having moved from a local practice.

Model of Care

Most of the GPs interviewed indicated that the models of care applied in the GP Super Clinics was a major factor in retention. In particular, many GPs indicated that the delineation of duties within the practices allowed them to focus on “their medical work” and allowed other disciplines to undertake other aspects of primary care such as chronic disease management. This aligns with evidence from the United Kingdom where GPs reported positive experiences with the delineation of workloads among disciplines, enabling them to focus on more complex patients.33

“I feel this is what I have been trained for. I can efficiently use my medical skills....and allow others such as the Chronic Disease Nurse to spend more time in developing and monitoring care plans....Working under this model is the most professionally fulfilled that I have been.”
GP - Interview

Clinicians were asked in the survey to indicate their levels of agreement with reasons for working in the GP Super Clinic (Table 15).

Table 15: Percentage of Clinicians Reporting Reasons for Working at GP Super Clinics

%^
95 % Confidence Interval
Commitment to provision of integrated care
92
82
98
Commitment to the provision of multi-disciplinary care
89
77
96
Opportunity to work with a range of disciplines
87
75
95
Strong approach to ensuring and monitoring quality
81
68
91
Service models meet the health needs of the community
77
64
88
Commitment to supporting and retaining staff
75
62
86
Multidisciplinary involvement in clinical governance
70
56
82
Flexible hours
68
54
80
Opportunity to participate in teaching/training of students/new graduates
57
42
70
Multidisciplinary involvement in organisational governance
57
42
70
Opportunity to participate in research
26
15
40

^ Percentage of clinician agreeing or strongly agreeing with each reason for working in clinic

The most important reason for participants working at the GP Super Clinics was commitment to provision of integrated care (92%; 95% CI 82%-98%), followed by commitment to provision of multidisciplinary care (89%; 95% CI 77%-96%) and opportunity to work with a range of disciplines (87%; 95% CI 75%-95%). The opportunity to participate in research was considered to be the least important reason for working at the GP Super Clinics (26%; 95% CI 15%-40%).

Teaching and Training

Many of the clinicians interviewed indicated that the opportunity for participating in teaching and training was a facilitator in commencing and maintaining their positions in the GP Super Clinics. This appeared to be related to a philosophical commitment to teaching and training, and the capacity to influence future graduates in their particular disciplines in the model of care. In addition, the inclusion of suitable space was a factor in their willingness and capacity to provide training.

There was a common perception that the model under which students and graduates would be trained at the GP Super Clinics would be substantially different from that experienced in other practices where clinicians had worked. In particular, it was expected but not totally realised that the opportunities for partnership approaches to teaching and training would be available in GP Super Clinics. In this way the GP Super Clinics could provide placements under a multi-disciplinary model and universities in return could align their teaching programs with this model of care.

Business Model and Financial Viability

The majority of GPs and other clinicians provided services at the GP Super Clinics under a contract based on a negotiated proportion of all patient-derived income. The majority of GPs interviewed indicated that the business model was a key element in their recruitment and retention. While not all indicated that the financial viability was optimal, they were positive that this would be reached within time. The business model allowed them to develop a sense of autonomy, albeit within a care team which provided the necessary clinical support.

A number of the GPs indicated that they had left profit-driven corporate models of General Practice where they perceived that salary differentials were inequitable and the model of care did not reflect their expectations for high quality primary care. In these instances, GPs expressed views that GP Super Clinics provided a balance between financial viability and their beliefs about high quality care which was not available in the corporate models in which they had worked.

Administrative support provided by the GP Super Clinics was also a factor in recruitment and retention. This was provided as part of the contractual arrangements for the clinicians. It was perceived as representing value-for-money for clinicians and ensured they could focus on clinical rather than administrative duties. Indeed, some who had been in practice as sole practitioners and/or business owners indicated that the administrative load in private practice was a factor in their decisions to seek alternative arrangements.

Misinformation

One issue which was unexpectedly raised as a barrier to recruitment, but not to retention, was the misinformation and adverse media coverage about GP Super Clinics at start-up. Many of the GP Super Clinic Directors reported they spent significant time, especially in the early stages, countering misinformation in the media and among the community about GP Super Clinics and the models of care. A number of clinicians also reported their initial concerns about commencing at the GP Super Clinics, given the negative media coverage. Indeed, some clinicians at a number of sites reported active campaigns run locally against GP Super Clinics, and the clinicians, usually by other doctors. This was perceived as due to threats about the GP Super Clinics providing unfair competition locally, in spite of many patients who indicated a reason for changing to the GP Super Clinics was inability to get timely appointments at other clinics.

The situation was reinforced by some patients indicating an initial feeling of wariness about the GP Super Clinics, given negative local media coverage. However, patients who raised this also indicated that their experiences at the GP Super Clinics differed from their expectations.

I’d read in the [local paper] about the clinic....I thought it was going to be like a big production factory....But after coming here now a few times it could not be further from the truth. I can get an appointment where at [previous clinic] I had to wait weeks. I can usually see a doctor that I want to see. Everyone is friendly. The service is much better...you are actually treated like a person, not a number. This is so what this area needed and I am not sure what all the fuss was about.

Patient - Interview

Some GP Super Clinic Directors also reported that they were now receiving calls from GPs expressing interest in working at the GP Super Clinic. Most commonly, the Directors reported that the interest of these GPs was based on a desire to work under the model of multi-disciplinary care provided at the GP Super Clinics.

33Lester H, Campbell S, McDonald R. The present state and future direction of primary care: a qualitative study of GPs’ views. British Journal of General Practice. 2009;59:208-215.