A Systems-Psychodynamic Exploration into GP Experiences of Current Changes in Healthcare Delivery

My research uses a psychosocial approach to undertake an exploration into general practitioners’ (GPs) experiences of current changes in healthcare delivery. Under the impact of the neoliberal paradigm and the challenges of running a general practice, GPs appear to have been retiring early, and it has been hard to recruit GPs for some years. At this time, when we are seeing an ageing population, increasing incidence of chronic comorbidities, and the development of clinical technologies, the biopsychosocial model of medicine has to contend with much complexity. Moreover, the nature of primary care is such that the business of general practice is also being challenged by the processes of commissioning, bidding and contracting required to sustain income and viability, with some practices joining together to form primary care networks in order to survive. All of these varying elements beg the question: what defines GPs’ primary tasks, roles and systems, and how might their motivation and identity be affected by this situation of clinical complexity and financial challenge in the healthcare context? Bringing in concepts from systems psychodynamics and organisational consultancy, this thesis considers both the doctor- and organisation-in-the-mind. Using a qualitative approach to explore these dynamics, semi-structured interviews were undertaken with 12 GPs at different stages of their career, with different interests and responsibilities. Ten themes were identified as pertinent to the sample, to varying degrees: 1) the long-term patient relationships – dependency and intimacy; 2) identification with the role, and the GP surgery as a second home; 3) underpinning ethical value systems; 4) satisfaction in one’s role as a clinical GP; 5) the systemic leadership role; 6) being overwhelmed by the context; 7) a business-minded approach to the financial state of the surgery and context; 8) determining one’s own timetable; 9) one’s own family or illness as a motivator; 10) family aspiration as a motivator.Three major clusters of responses were identified, revealing three GP types with varying social defences and valencies for individual and group functioning. The neoliberal paradigm, together with managerialism, changes in funding methodology, the erosion of social support systems, an ageing population, advanced medical technologies and other issues, appear to have disrupted GPs status as the family-doctor-in-the-mind committed to caring for patients from cradle to grave. An increasing ambivalence about meeting the demands of patient dependency, and a turning away from the responsibilities of full-time partnerships in general practice, is an identifiable trend. In addition, my research identifies the alternative allure of entrepreneurial activity and engagement with both organisational demands and novel clinical pathways in the wider system of healthcare. Through the application of the metaphor of the periodic table, a hypothetical model is tentatively offered comprising the three GP types in order to consider not only the effect on individual GPs but also the possible impact on general practice as an institution.