How do general practitioners choose their practice? Preferences for practice and job characteristics

To investigate the strength of preferences for practice and job characteristics among recently appointed general practitioners (GPs) in south-east England.

Conjoint analysis based on a postal questionnaire survey of all 293 GPs who joined a new practice between April 1997 and March 1998 in London, Essex and Hertfordshire. GPs were presented with descriptions of practices in pairs, which varied systematically for key characteristics, and asked to indicate their preferred practice in each pair.

The response rate was 58.7%. The most important influence on GPs' choice of practice was aversion to location in an area of high deprivation. They were more likely to choose a practice that: had an extended primary health care team; offered opportunities to develop outside interests; and offered them higher income, shorter working hours and smaller list sizes. The model generated estimates of the strength of these preferences. For example, GPs would require additional income of just over 5000 Pounds per annum to work in an area with a high proportion of deprived patients.

Potential policy interventions to attract GPs to under-served areas include increasing their level of remuneration, providing opportunities to develop outside interests and ensuring that practices have a primary health care team.