Investigating the conditions in which women GPs thrive in General Practice: What works, for whom, how and in what circumstances?

Research questions

1. What are the mechanisms acting at an individual, team, organisational, and societal level that affect women GPs health and wellbeing; performance; and carer progression; 2. In what contexts are these mechanisms triggered (or not triggered)? 3. What outcomes (both intended and unintended) do these contexts and mechanisms lead to?

4. What interventions/ strategies can be implemented to help women GPs to thrive at work, based on relevant contexts, mechanisms and outcomes? 5. What are the critical gaps in the literature (including the views and experiences of women and minoritized women)?

Background: Women now make up approximately half the GP workforce (RCGP, 2022). However large numbers between the ages of 30-44 are leaving the profession (RCGP, 2022). Women GPs are disproportionately affected by higher rates of burnout, stress and anxiety (Jefferson et al., 2022a), suicide (Brooks, 2020), and lower rates of career progression (Jefferson et al., 2022b).

Additionally, they also take on a greater load of emotional labour, demonstrating higher levels of empathy and spending longer talking to patients about their emotions and feelings (Howick et al, 2017; Jefferson et al., 2013). Although patients value being seen by women GPs (Pineault et al., 2017), this additional investment in patient care can contribute to higher rates of burnout and subsequent intention to leave.

Retaining this staff group is one of five priorities for future policy and research (RCGP, 2022). Immediate policies are necessary to solve the current workforce crisis. One possibility is offered through the notion of ‘thriving at work’, which can enhance both individual health outcomes (such as lowering burnout) and organisational level outcomes (such as commitment job satisfaction and retention) (Kleine et al., 2019).

Thriving at work is the state of functioning positively in mental, physical, and social domains (Brown et al., 2017). It is a multi-faceted state that is associated with several individual and organisational outcomes such as enhanced health and reduced burnout and organisational commitment (Kleine et al., 2019; Alwahhabi et al., 2023). Thriving at work facilitates a healthy workplace and sustainable performance (Abid et al., 2022).

The ability to thrive (or not) is context specific; what helps some to thrive, may not be the same for others. Our interdisciplinary evidence synthesis will help to facilitate understanding that may support health service providers improve women GPs’ wellbeing and retention.

Aims and objectives: This research aims to bring together the breadth of interdisciplinary research and synthesise evidence on how general practice workplaces can best support women GPs to thrive.

Methods: We propose to undertake a realist review. Realist reviews seek to understand why an intervention may work in one context but not another. This involves building an understanding of how various contextual factors affect the activation of mechanisms (i.e., changes in participant reasoning or behaviours) to produce various outcomes.

Timelines for delivery: This project will run across 18 months starting in November 2024 and finishing in April 2026.