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Ss 3

 

The combination of a NIHR-funded ACL post, SPCR-funded projects and colleagues with expertise in workforce research, has made it possible to design, propose, develop, manage and conduct investigations of an important and topical problem, to deliver outputs for dissemination, and to build confidence, networks and collaborations which will help in developing future research projects."  
- Dr Sharon Spooner

Dr Sharon Spooner, Clinical Lecturer at the University of Manchester’s Centre for Primary Care, received news of a Health Services and Delivery Research (HS&DR) award to the tune of £850k in Spring 2018. She spoke to the SPCR about how this award highlights the important role of seed funding, received from the School in 2015-2017, in the development of ideas and researcher experience for this new project.  

Building on Sharon’s experience as a clinician and researcher, the HS&DR research will consider the scale, scope and impact of skill mix changes in general practice, “My interest in workforce research has emerged from my first-hand knowledge of changes affecting GP work, and the difficulties surrounding GP recruitment and retention. It is now increasingly acknowledged that a combination of factors, including, but not limited to: rising workloads; low recruitment; and early retirement changes; have resulted in a very stretched GP workforce. GPs report high levels of job stress and are concerned about how they can maintain quality and safety for their patients.”

WHAT IS THE MAIN FOCUS OF YOUR HS&DR RESEARCH?

We will investigate the types of practitioners (GP and non-GP practitioners) being employed in general practices in England. We will look at why particular types of practitioners are employed, how they work together, and what patients think about consulting with practitioners from different disciplinary backgrounds.

The project will also investigate how changing patterns of skill mix are associated with markers of quality of healthcare and the overall costs to the NHS. This will provide a more comprehensive understanding of what, where, when and how better outcomes for patients, general practice staff, and the NHS as a whole, may be achieved through changes in skill mix employment.

WHAT DID YOUR SPCR FUNDED PROJECTS INVESTIGATE?

My appointment as a NIHR ACL at the Centre for Primary Care Research in Manchester in 2014  has enabled me to work with experienced colleagues already active in GP workforce research (e.g. the National GP Worklife Survey series) and to apply for SPCR funding.

My first study; An investigation of the factors behind the training choices of junior doctors which result in inadequate recruitment to general practice careers (FACSTiM) explored the issues behind unfilled places on GP ST programmes.

An online survey, completed by over 800 Foundation Programme Year 2 doctors, asked them to select which job characteristics they would prefer in their future career and which of these they associated with general practice work. We also gathered data about personal demographics and career plans. In-depth interviews explored their experiences of medical school and early medical work and investigated how these affected their career preferences.  

Limited research and much anecdotal evidence has indicated that many newly qualified GPs do not make a smooth or rapid transition into settled and substantive GP work in the UK. Therefore, my second SPCR-funded project, An investigation of factors which are associated with successful transitions from GP Specialty Training Programmes to long-term careers in NHS general practice  (FIT2GP)  is an investigation of the next career-decision point for potential GPs; the completion of training and prospect of progression from supervised training posts to working as fully qualified GPs. Our qualitative study is still in progress, however themes emerging in early analysis is already informing the development of a third project; New GP career intentions and training experiences (NCITE) and is a collaboration with the RCGP. This is led by a colleague from FACSTiM and is supported by SPCR.

HAVE YOU PUBLISHED THE FINDINGS?

To date we have published two papers reporting findings from FACSTiM.

Stick or twist? Career decision-making during contractual uncertainty for NHS junior doctors, reported on a significant shift from ST programmes for some acute hospital specialisms towards general practice ST and was published in BMJ Open, 7, 1;  by SPOONER, S., GIBSON, J., RIGBY, D., SUTTON, M., PEARSON, E. & CHECKLAND, K. 2017.

The study coincided with an unprecedented period of industrial action during the junior doctors’ dispute and meant that we were able to observe that many doctors altered their preferred career choice in response to a controversial new contract for junior doctors.

How do workplaces, working practices and colleagues affect UK doctors’ career decisions? A qualitative study of junior doctors’ career decision making in the UK, published in BMJ Open, 7, 10 by SPOONER, S., PEARSON, E., GIBSON, J. & CHECKLAND, K., explored themes emerging from interviews with junior doctors from diverse backgrounds and who preferred a range of medical specialties. The paper highlights the importance of understanding how perceptions are formed and preferences are developed, as a basis for generating learning and working environments that nurture students and motivate their professional careers.

Oral presentations of the survey data (and a working paper) confirm how the  preferred job characteristics of doctors choosing and not choosing GP ST show significant divergence.  

Findings from FACSTiM (and early emerging themes from FIT2GP) have informed several oral and poster presentations; an interactive SAPC Workshop, shared with research colleagues from Nottingham and Exeter led to publication of a joint paper in BJGP which highlighted the importance of a career-long approach to understanding and supporting the work done by GPs:  The GP workforce pipeline: increasing the flow and plugging the leaks. SPOONER, S., FLETCHER, E., ANDERSON, C. & CAMPBELL, J. L. 2018. British Journal of General Practice, 68, 245-246.

Did these findings help secure your new award?

Whilst the findings emerging from both studies contribute to knowledge about GP recruitment and early career retention, I believe it has been the provision of opportunities to gain experience as a Principal Investigator that has been immensely influential in securing the new HSDR award. The combination of a NIHR-funded ACL post, SPCR-funded projects and colleagues with expertise in workforce research, has made it possible to design, propose, develop, manage and conduct investigations of an important and topical problem, to deliver outputs for dissemination, and to build confidence, networks and collaborations which will help in developing future research projects.  

 Read the announcement on the University of Manchester's website