Workload pressures in rural general practice: a qualitative investigation

OBJECTIVE: To examine whether there are workload pressures, as reported by healthcare professionals, which are unique to rural general practice. DESIGN: Semi-structured face-to-face interviews with staff from general practice teams located in different geographical areas. SETTING: The north-east of Scotland (Grampian). PARTICIPANTS: 16 GPs, 14 practice nurses, 9 practice managers and 14 administrative staff from 14 general practice teams. MAIN OUTCOME MEASURES: Recurrent themes were identified by the systematic analysis of interview transcripts. RESULTS: Workload pressures experienced at aDl locations included continual change, increased volumes of administration and dealing with rising patient expectations. Workload pressures particular to rural areas were long periods on-call and difficulties in taking time off from the practice, the "specialist-generalist" role of rural practitioners and feelings of responsibility, including a pastoral role within the community. CONCLUSION: Although some workload pressures exist regardless of location, rural practices appear to have some unique difficulties. Solutions which help practices cope with change and demand will be useful to both rural and urban practices. Staff from rural practices, however, also need location-specific solutions, such as those for reducing stress from being on-call for prolonged periods.