ABSTRACT
The clinical pressures of general practice are dynamic. Because general practitioners (GPs) are embedded in the communities in which they work, the nature of their work changes rapidly with the population around them. Increasing workload was cited as the top stressor by the GPs surveyed in the National GP Worklife Survey in 2015, and the changing and growing nature of the general practice workload, and the associated stress of this change and growth, emerged as the main theme in a study looking at the retention of the general practice workforce. The National Health Service (NHS) had division between primary care and secondary care woven into its fabric from its inception, but this division was formalised, and arguably entrenched, by the formation of the internal market and the purchaser–provider split in 1991. In the confusing environment of repeated tendering processes, and of restructuring and reorganisation, it is also difficult for general practices to form reliable institutional relationships with secondary care providers.
