Is there a doctor in the house? Systems-psychodynamic research into general practitioners’ experiences of changes in healthcare delivery

Abstract

My qualitative research uses a psychosocial approach to explore GPs’ experiences during changes in healthcare delivery prior to the impact of the Covid-19 pandemic. The challenges of running everyday general practice under the neoliberal paradigm meant that GPs were retiring early, and that new GPs were hard to recruit. Even before March 2020, the biopsychosocial model of medicine was contending with many complexities, including workforce shortages, an ageing population, increas-ing incidence of chronic comorbidity, and the development of clinical technologies, to name but a few. General practice is also challenged by the requirements of com-missioning, bidding, and contracting in order to sustain income and viability. What defines GPs’ primary tasks, roles, and systems, and how are GPs’ motivations and identities affected by this situation of clinical complexity and financial challenge? My research reveals three types of GP and an ecosystem’s model of the organisation-in-the-mind, involving various social defences and valencies for individual and group functioning.