‘Hidden in plain sight’; the unseen work of general practitioners in general practices in England
- Principal Investigator: Sharon Spooner
- 1 June 2022 to 31 October 2023
- Project No: 573
- Funding round: FR3
Why this research is important
In recent years, the number of patients and their healthcare needs have grown faster than the number of General Practitioners (GPs) available to provide care. The shortage of GPs to deliver increasingly complex care leads to longer waiting times for appointments and fewer opportunities for patients to see their preferred GP.
Many GPs say that their work is becoming more intense and stressful. Research confirms that consultations often involve patients with multiple problems, making it difficult to deal with everything in one appointment. Another source of work pressure lies in doing essential (‘hidden’) background work. This work includes preparing referral letters, checking test results, and ensuring prescribed medication adjustments are processed correctly. Additional workload arises when work is passed back to primary care from hospital settings. Examples include: requests to refer to another specialist; monitor blood results or follow-up abnormal clinical findings; or because a patient mentions additional problems. While different types of health professional are now employed to ease workload pressure on GPs, no research has looked in detail at GPs’ ‘hidden’ work, and the continuing demands on their time within these new working arrangements. To improve GPs’ working lives, we first need to understand the nature of this work and its impact by studying it first-hand in general practices.
What we plan to do
This research will serve three important purposes: 1) to work with GPs and practice staff to identify which research methods are feasible, acceptable and productive in shedding light on hidden work, 2) to use these methods to discover the nature and impact of GPs’ hidden work, and 3) to invite GPs and practice staff to participate in a reflexive workshop for collective learning.
First, we will study what GPs’ working day involves in two practices. We will choose practices in different locations, serving different patient populations, and include GPs with a range of working experience (e.g. partners, salaried GPs, years since qualification). We will pilot several methods of data collection to find out what GPs do and how they feel about it.
• Interviews with GPs to find out what their working day involves, focussing on work outside of patient-focussed, scheduled consulting time.
• Observations of the work GPs do which patients do not usually see. We will investigate when they do this and document the nature of the work, who is involved, and trace connections between different kinds of work.
• Data-gathering options will include audio-recordings, reflective prompts, audio-diaries, written reflections or video-recordings, according to what GPs prefer.
• In each practice, we will arrange a reflexive workshop with GPs and staff, sharing short data extracts to prompt inter-professional discussion and learning, and to review our use of different research methods.
Amount Awarded: £140,000