New research finds rising workloads and administrative burdens are increasing work intensity and affecting GP wellbeing. Niamh Cahill reports
Targeted strategies are required to reduce the strain in Irish general practice, according to a new study.
The study, titled ‘“There is never any rest, never enough time and too much to do”: A qualitative study of GP work intensity in an Irish context’, was recently published in BMC Primary Care.
The research was carried out by clinicians from the RCSI, Irish College of GPs, University of Galway, and Trinity College Dublin. The project was funded by a Health Research Board Applied Partnership Award and undertaken in collaboration with the Irish College of GPs.
Some 20 GPs participated in two semi-structured interviews and an eight-week instant messaging conversation via the Threema platform. The data collection took place between October 2024 and July 2025.
The researchers outlined the fact that general practice is under pressure in many countries due to recruitment and retention challenges.
“Ireland also faces increased demand for primary care as a result of its ageing population, increased incidence of chronic illness, and greater patient complexity. Significantly more GPs will be needed to meet this increased demand,” according to the study.
“The GP workforce in Ireland is ageing; in 2022, one-quarter of Ireland’s GPs were over the age of 60. This is of particular importance to workforce planning, as older GPs tend to work longer hours. In the current GP workforce, almost one-third of GPs report working 30 hours or less a week in general practice, indicating changing working practices that need to be understood and incorporated into workforce planning.”
A separate paper by the authors had described these changes to GPs’ working lives. The paper explained how GPs are opting to reduce their patient-facing work in response to high work intensity. GPs are also reducing their overall working hours to improve their work/life balance.
The most recent study further builds on this research by focusing on the sources of work intensity for GPs in Ireland.
The authors grouped the results into three categories: The sources of work intensity for GPs; the impact of work intensity on GP wellbeing; and how to address GP work intensity.
Findings
Participating GPs reported feeling their workload was unmanageable and that they regularly worked outside of core working hours.
One participant remarked: “There is never any rest, never enough time and too much to do.”
Patient complexity, patient demand, and the administrative workload were all listed as sources of work intensity.
GPs’ work/life balance also suffered and GPs reported experiencing isolation at work, with limited time to interact with colleagues.
The impact of the introduction of the chronic disease management (CDM) programme in general practice was also explored in the study.
“The CDM programme entitles public patients with specific chronic conditions to government-subsidised bi-annual reviews by their GP. While this was viewed positively by most GP participants, it was also considered to have reduced their capacity for acute appointments,” the study reported.
“Complex patients require longer appointment times than the standard 10–15 minute appointment, they tend to generate more paperwork, and involve more complex pharmaceutical management.”
Changes in patient demand and expectations were also noted by participants. While new developments in healthcare are to be welcomed, it was noted this can contribute to a rise in demand from patients for GP care.
The research explored ways of tackling the problem. The impact of scheduling and patient numbers was highlighted. But the researchers expressed caution about several challenges in this area.
“To an extent, GPs’ experiences of work intensity were dependent on practice-level decisions around patient numbers, scheduling, locum cover, and the availability of protected administrative time,” the authors wrote.
“At a practice level, the decision to enact these types of practices can be constrained by financial considerations. They may also sometimes be out of the hands of GP principals, for instance if additional public patients are assigned to a GP practice by the HSE, increasing patient list sizes or the availability of locums to cover holiday and sick leave.”
The researchers concluded that the study demonstrated the very high volume and intensity of work among GPs in Ireland. They indicated this was similar to the experience of GPs working in the UK and US.
The research highlighted the often-conflicting needs of individual GPs, GP practices, and the wider healthcare system.
“Clearly, GP practices limiting their patient numbers, etc, will have implications for workforce requirements into the future, much as individual GPs changing their working practices to cope with intensity will,” the study outlined.
It stated that improved GP retention, among other actions, were required to protect the wellbeing of GPs.
The researchers recommended that to do this and to secure the future sustainability of the GP workforce, the causes of work intensity must be “better understood and factored into GP workforce planning”.
“Future research should examine the potential organisational and system-level solutions that might help to mitigate GP work intensity.”
Future research should examine the potential organisational and system-level solutions that might help to mitigate GP work intensity
Sustainability
Dr Niamh Humphries (PhD), study co-author and Senior Lecturer and Head of Research at the RCSI Graduate School of Healthcare Management, told the Medical Independent (MI) that the study highlights the increased work intensity for GPs and the impact this is having on their working lives and wellbeing.
“It raises important issues around workloads which are relevant for the individual GPs as well as for the collective GP profession and workforce,” Dr Humphries said.
“In order to encourage GP retention, we need to factor in wellbeing and sustainability and ensure that GPs have sustainable careers with sustainable workloads so that they can work without sacrificing their wellbeing or work/life balance.
“I think this type of research is critical for helping us to understand the everyday work-as-done by GPs. It’s also so important that these findings inform policy and practice in relation to GP retention and GP workforce planning.”
Dr Humphries added: “Ideally, there would be dedicated research funding available for health workforce research given its importance to Irish health workers, to the health system, and to future healthcare delivery.”
Changed landscape
Dr Tadhg Crowley, Chair of the IMO GP committee, told MI the study reflected the changes that have taken place in general practice in the past decade.
As the research outlined, the nature of GP work is evolving, due in part to the rise in use of online and walk-in clinics.
“Firstly, greater online GP access has increased the expectations that people have,” Dr Crowley said.
“Secondly, you’re dealing with more complex medical issues and cases and there are longer waiting lists now for patients to get seen and the GP is seeing more and doing more in general practice.
“With the shortage of GPs there is a big demand for patient services and that increases the pressures… it’s got more complex with more chronic diseases. It reflects what people have been saying to us about general practice in the last five to 10 years.”
Leave a Reply
You must be logged in to post a comment.