Team climate, job satisfaction, burnout and practice performance: results of a national survey of staff in general practices in England.

Background: Measures are needed to address recruitment and retention problems in general practice in England. A good team climate, the relational processes of team working, can mitigate pressured work environments, but little is known about it.

Objectives: To explore factors associated with more favourable team climates in general practices and investigate associations between team climate and outcomes for staff and practice performance.

Methods: All 6475 general practices in England were eligible to take part in an online cross-sectional survey. Clinical and non-clinical staff in practices were invited to participate. Data were gathered using the 14 item version of the Team Climate Inventory; analysis was conducted on 10 items because piloting indicated many participants could not answer four items about practice objectives. Secondary outcomes included single item measures of job satisfaction, intention to remain working in the practice and burnout. Practice performance measures were: attainment in the Quality and Outcomes pay-for-performance system (for clinical effectiveness) and patient experience ratings from the national General Practice Patient Survey. Staff outcomes were analysed, principally by role. Practices in which over 50% of staff participated were included in modelling of practice level outcomes.

Results: A total of 9835 individual members of staff from 809 practices participated. Most indicated a favourable team climate in their practice, (mean 3.77, on scale 1-5 best, SD 0.84); 61.3% stated they were mostly or extremely satisfied in their jobs; 26.1% met the criteria for high burnout. General Practitioners, compared to other clinical and non-clinical staff, perceived team climate to be better, and reported less likelihood of leaving, yet lower job satisfaction and higher burnout. In practice-level modelling, team climate improved as practice size decreased. Staff outcomes (job satisfaction, likelihood of remaining in post, less burnout) were associated with a better practice team climate, as were patient experience ratings. Higher GP to patient ratios were associated with improved job satisfaction, less burnout and more favourable patient experience ratings.

Conclusions: Policies focussed on improving team climate could improve staff outcomes and contribute to mitigating the workforce crisis in general practice in England. Guidance on fostering good team climates is needed for practices.