Predictors and population health outcomes of persistent high GP turnover in English general practices: a retrospective observational study

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Objective English primary care faces significant challenges, including ‘persistent high turnover’ of general practitioners (GPs) in some partnerships. It is unknown whether there are specific predictors of persistent high turnover and whether it is associated with poorer population health outcomes.

Design A retrospective observational study.

Methods We linked workforce data on individual GPs to practice-level data from Hospital Episode Statistics and the GP Patient Survey (2007–2019). We classified practices as experiencing persistent high turnover if more than 10% of GPs changed in at least 3 consecutive years. We used multivariable logistic or linear regression models for panel data with random effects to identify practice characteristics that predicted persistent high turnover and associations of practice outcomes (higher emergency hospital use and patient experience of continuity of care, access to care and overall patient satisfaction) with persistent high turnover.

Results Each year, 6% of English practices experienced persistent high turnover, with a maximum of 9% (688/7619) in 2014. Larger practices, in more deprived areas and with a higher morbidity burden were more likely to experience persistent high turnover. Persistent high turnover was associated with 1.8 (95% CI 1.5 to 2.1) more emergency hospital attendances per 100 patients, 0.1 (95% CI 0.1 to 0.2) more admissions per 100 patients, 5.2% (95% CI −5.6% to −4.9%) fewer people seeing their preferred doctor, 10.6% (95% CI−11.4% to −9.8%) fewer people reporting obtaining an appointment on the same day and 1.3% (95% CI −1.6% to −1.1%) lower overall satisfaction with the practice.

Conclusions Persistent high turnover is independently linked to indicators of poorer service and health outcomes. Although causality needs to be further investigated, strategies and policies may be needed to both reduce high turnover and support practices facing challenges with high GP turnover when it occurs.
Original languageEnglish
JournalBMJ Quality and Safety online first
Publication statusPublished - 24 Jan 2023


  • General practice
  • Health policy
  • Health services research


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