Dilemmas in the development of the general practitioner workforce in primary care: a qualitative study in Beijing, China

Background The general practitioner workforce (GPWF) is an important factor influencing primary care capacity. Many countries face GP shortages and substantial challenges in workforce development. However, the factors and mechanisms shaping GPWF development remain insufficiently understood. Purpose To explore key challenges affecting GPWF development and their interrelationships in the primary care system of Beijing, China. Methods Between October and December 2024, directors and GPs from 18 community health centres were recruited using purposive sampling. Data were collected through a focus group discussion and in-depth interviews; thematic analysis was conducted in line with Merriam and Tisdell’s approach. A causal loop diagram (CLD) was then developed to identify and visualise dynamic relationships among factors influencing the GPWF development. Results The participants comprised 10 directors and 8 GPs from urban and suburban areas, with a predominance of women and those holding senior professional titles. Participants had diverse educational and professional backgrounds. Three major themes were identified: (1) rising demand for GP services, (2) supply challenges in the GPWF, and (3) challenges to GPs’ professional sustainability. Across these themes, 12 subthemes and 10 key variables were identified. The CLD reflected participants’ perceptions of how these variables interacted and illustrated potential reinforcing interactions among them. Conclusion The development of the GPWF in Beijing is constrained by multiple interrelated challenges. Addressing these challenges entails coordinated policy actions to strengthen workforce planning and training, enhance job attractiveness, improve the alignment between training and practice, and reinforce professional support and continuing professional development, thereby promoting the sustainability of the GPWF.