Background UK GPs are quitting direct patient care. The research presented here is part of a wider mixed methods study (ReGROUP) which focuses on retention of the experienced GP workforce, and on supporting the return to work of GPs following a career break. We undertook a qualitative synthesis of the evidence to identify factors that affect GPs’ retention in the workforce and that affect GPs’ decisions to quit direct patient care, take career breaks from general practice, and return to general practice after a career break

Methods Five UK interview-based studies were identified and quality assessed using the adapted “Wallace tool”. A thematic synthesis was performed using NVivo software and a detailed explanatory model was constructed to provide an overview of the key contexts and factors affecting UK GPs in practice. Applicability of the explanatory model was verified by patient representatives in a patient and public involvement (PPI) workshop as well as by stakeholders from the wider research team.

Results Three central dynamics key to understanding UK GP quitting behaviour emerged – factors associated with low job satisfaction, high job satisfaction, and those linked to the doctor-patient relationship. The importance of contextual influence, especially the changing nature of clinical practice, was noted. GPs with high job satisfaction describe feeling supported by good practice relationships, while GPs with poor job satisfaction report feeling overworked and unsupported.

Combined with changing relationships with patients and interfaces with secondary care, and the gradual sense of loss of control over large parts of the job, many GPs report a reduction in job satisfaction. Once job satisfaction has become negatively impacted, the combined pressures of increased patient demand and workload together with other stress factors has left many feeling unsupported and vulnerable to burnout and ill health, and, ultimately, to the decision to leave general practice.

Conclusion Job satisfaction appears to be a key indicator of whether a GP will successfully adapt and remain in practice, or will become overwhelmed by external influences and pressures and leave the profession. Many GPs report that job satisfaction directly relates to the quality of the doctor-patient relationship, and is dependent on the time available for GPs to spend with their patients.