Faced with an aging population and the falling popularity of general practice as a career there have been concerns that the future Scottish general practitioner (GP) work force may be insufficient to manage a rising clinical workload [1]. As in other countries [2], there has been a marked increase in the proportion of general practitioners who are women, partly due to a falling interest in general practice by men and partly to the steadily increasing proportion of women medical graduates [3]. This has led to further concerns that the capacity of the workforce might be reduced by part-time working in Scotland. While raw numbers of principals and non-principals in Scotland had been rising [4], little is known about how much time each of these groups is spending on general medical services (GMS) or other activities nor what their future career intentions are.
General practice in the UK is largely managed in partnerships of GPs with a few working single-handedly [5]. Up until April 2004 most of these general practitioners contracted to provide general medical services for local primary care organisations and were known as principals. Their remuneration was based on the size of the patient list they looked after and on payments for a small number of item of service fees. As independent contractors they could take other employment opportunities for example as GP educators, in primary care administration and private health care. Individual remuneration within partnerships was agreed on the basis of day-time and out-of-hours workload. Some of these doctors had entered into a special type of contract with primary care organisations to provide Personal Medical Services under which they contracted to achieve specific targets in addition to GMS.
Another group of doctors known as non-principals did not usually have a direct contract with a primary care organisation but worked as locums, assistants or on the doctors retainer scheme (a scheme to maintain doctors with domestic commitments in practice) and were employed usually on a sessional basis by GP principals (a session is a half-day roughly 3.5–4 hours). These doctors generally spend less time on the managerial and strategic planning aspects of general practice and they were largely made up of relatively young women. They too were free to take up other types of employment. In April 2004 these titles were re-designated with all doctors providing primary care services now called performers and those with contracts to provide services with the local primary care organisations additionally called providers. However despite the change in name their day-time roles remained largely the same and work patterns were maintained. Out-of-hours responsibilities passed away from GP principals to primary care organisations in April 2004.
Current information on workload relies largely on contractual information which formerly divided principals into those working in to part-time (two categories), job share or full time which was defined as more than 26 hours per week. Information on non-principals was largely restricted to those who worked on the retainer scheme and a small group of practice assistants. Little at all is known about the workload contribution of the increasingly large number of doctors who work as locums in primary care.
While it was largely assumed that doctors contracted to work more than 26 hours were working considerably more than this, it is not known to what extent doctors were working either above or below their contracted hours or if some of the contracted hours were being taken up either with National Health Service (NHS) related activity (for example working for local health care co-operatives), education, research or private medical work. The last re-organisation of the health service (1991) saw many doctors take roles in NHS management and in specialist clinics and there has been a shift of medical undergraduate education to the community.
Although the number of full-time equivalent GP principals in Scotland has been steadily rising, this increase is largely due to women doctors [6]. It has not been clear if "full-time" women doctors contribute the same number of hours as "full-time" men nor what their work pattern was in relation to non-GMS but NHS related work.
Information on workload is very sensitive as it may reveal a situation where some doctors who may be paid as 'full-time' were in reality spending only half of this time on NHS related work. Potentially, previous non-anonymous surveys may have resulted in a perception of workload that was inflated because of concerns on the part of some respondents about revealing contractual non-adherence[7].
In addition there is very little information on future work intentions. While there have been studies on retirement intentions [8–10], these have not always included the non-principal groups and there has been relatively little work on how doctors anticipate their workload changing in the future. This is particularly important for the large number of doctors currently working part-time, on retainer schemes or as locums. Likewise it is important to determine if there are differences between men in women in terms of their long term commitment to service provision in relation to their retirement plans.
The aim of this study was to discover how male and female general practice performers (formerly general practice unrestricted principals (henceforth referred to as GP principals) and non-principals) divided their time between general medical service (GMS) activity and other activities such as teaching and administrative tasks. In order to obtain an honest picture of current GMS and non-GMS workload we decided to use an anonymous survey method. As out-of hours work was shortly to be contracted out we decided to restrict our survey to in-hours work.
