Today, general practice employs a diverse range of professional groups, driven by growing demand for complex healthcare services and the aim of relieving the burden on GPs. This has sparked speculations about whether this development truly alleviates the workload on GPs.

Two Danish researchers have investigated whether the composition of employees with different professional skills (skill mix) in the clinic is associated with the GPs' total working hours and their risk of burnout. The results have just been published in the international journal Family Practice.

“This study is the first to investigate associations between GP well-being and practice organisation in Denmark,’ according to the lead author of the paper, Anette Fischer Pedersen, psychologist and senior researcher at the Research Unit for General Practice in Aarhus.

Nurses are associated with lower risk of burnout

The new study suggests that employing nurses may be associated with a lower risk of burnout among GPs.

“When a GP can confidently delegate selected consultations and follow-ups for chronic diseases to a nurse, this appears to ease the workload and increase their job satisfaction,” explains Anette Fischer Pedersen.

Notably, the employment of a broad category of healthcare professionals (e.g. midwives, laboratory technicians, physiotherapists, pharmacists and psychologists – but not medical secretaries/receptionists) seems to be associated with a higher risk of burnout among GPs in partnership practices. Single-handed practices were less likely to employ this broad type of staff.

GPs spent more hours on management

Using supportive staff in the clinic was not associated with the number of hours the GPs reported spending per week in the clinic. However, the GPs spent their time differently.

“Hiring one or more individuals from the broad category of healthcare professionals was associated with an increased number of GP hours spent on management in both partnership practices and single-handed practices,” elaborates Anette Fischer Pedersen.

More staff can both relieve and challenge GPs

Studies from the United Kingdom have previously suggested an association between having many employees from the broad category of healthcare professionals in the clinic and lower job satisfaction among GPs. 

According to Anette Fischer Pedersen, this may be because the GPs must spend time guiding new staff before they can benefit from additional workforce capacity. Another possible explanation is that GPs receive more questions and are left with the most challenging patients with the most complex health problems. Furthermore, previous studies suggest that involving a wide range of healthcare professionals may lead to lower patient satisfaction, partly because patient knowledge is distributed among multiple staff members in the clinic.

It is essential that patient information be shared and care coordinated among the various healthcare professionals. This necessitates a well-functioning team with mutual understanding of the work and of each other, which may also account for the positive role that nurses seem to play.

Causal relations not identified

This area warrants further investigation, e.g. longitudinal studies, to allow closer monitoring of trends over time and to clarify whether organisational changes in general practice are affecting patients unequally.

The results indicate that delegating tasks from GPs to nurses may reduce GP's workload, but the study design precludes any causal inferences.

Read the scientific article ”Skill mix in primary care, working hours, time used on management, and burnout among general practitioners” in Family Practice.

More information

Senior researcher, psychologist Anette Fischer Pedersen 
Research Unit for General Practice, Aarhus
Phone: +45 2963 8004
Email: afp@ph.au.dk