For many GPs, it is essential that their work is purposeful, significant, and aligns with their core values (11, 30, 49–51). When GPs are able to allocate time to aspects of their practice they consider meaningful (e.g. direct doctor-patient interactions, or administrative tasks pertaining to known patients), they are more engaged in their work, because they experience a sense of congruence or alignment between their core values and the nature of work (CMOC1) (5, 27, 43, 49–55). The experiences and perceptions of meaningful work varied among GPs. GPs derive unity, purpose, and meaning through long-term therapeutic relationships with patients and families, in addition to performing patient advocacy, health promotion work, community participation, and improving local service provision (5, 11, 27, 30, 35, 46, 49, 54, 56–62).

GPs find intellectual stimulation in managing ill-defined illnesses, chronic complex multimorbidity, and accurate diagnoses (5, 27, 38, 49, 56, 62–64). GPs indicated the highest level of satisfaction and meaning when experiencing feelings of competency and mastery (5, 11, 56), and from consultations in which they perceived their personal contributions to have resulted in successful patient outcomes (27, 49). The act of mentoring and teaching medical students and junior colleagues through involvement in undergraduate and postgraduate training schemes is also particularly meaningful (43, 49, 52, 62, 65). Many GPs value the opportunity to contribute to the professional development of others and to reciprocate the support they received during their own training (27).

Various challenges prevent GPs from engaging in meaningful work. To address these challenges, work must be proportionate and structured to enable GPs to maintain meaning. In contexts where policies and guidelines emphasise GP work as compartmentalised (e.g. single disease management) and/or commodified (e.g. payment/reward), this can distort the doctor-patient relationship, as GPs experience pressure to reduce opportunities for therapeutic connections, situated knowledge, and continuity of care (CMOC2) (27, 29, 66). This can compromise GPs’ ability to address diverse patient needs, disproportionately affecting the most vulnerable and socioeconomically disadvantaged patients (19, 27, 50, 54, 57, 65). Many GPs find aspects of their work intellectually stimulating, fulfilling, and meaningful. However, most report pressure to balance patient/carer needs against target-driven accountability, stringent bureaucratic monitoring, and a standards-driven reward system (5, 27–29, 38, 50, 65, 67, 68). While larger practice sizes do not inhibit meaningful work, certain common at-scale organisational approaches (e.g. task delegation) can disintegrate and/or compartmentalise work (e.g. repeat prescribing, filing results, and acute provision of clinical care), minimising personal continuity and reducing opportunities for meaningful connections (36).

Media and policy attention has recently oriented general practice systems towards prioritising rapid access, superseding many key elements for sustainable, meaningful, and equitable general practice (19, 69). A critical factor that our PPI co-applicants identified and supported in our literature analysis was the importance of mutual and reciprocal care (CMOC3): “What about patient care for their GP?”. Current policies tend to position ‘patient demand’ as a fixed entity (and often expanding/overwhelming). Our analysis demonstrated that demand can be viewed as dynamic: constructed and negotiated through social interactions between patients and their GPs and practices. When systems become depersonalised (e.g. prioritising the speed of triage/access), the individual relationships between clinicians and patients can diminish (19, 50). Patients may be (re)positioned as consumers and experience reduced personal connections with their GP or practice. This can limit opportunities for GP ‘holding work’ (also identified in primary care link worker roles (70)) and follow-up appointments to help patients manage anxieties, concerns, and healthcare navigation. Without a sense of connection, patients may feel overwhelmed and perceive a need to seek more frequent or urgent attention.

When familiarity with a practitioner exists, patients are more likely to establish trust and feel cared for by the GP. This familiarity facilitates opportunities for collaborative preparation or pre-emptive planning regarding ‘what to look out for’ or ‘when to worry’, as well as a mutual understanding of temporal expectations (e.g. previous patterns for these symptoms and/or this patient, plus likely duration self-limiting, short- or long-term). Patients can reciprocate care and empathy for their practitioners and can (when safe) moderate their help-seeking behaviours where they feel they have adequate information and trust their practitioner, minimising a sense of crisis and perceived urgency of healthcare needs (19, 30, 60, 62).

Impersonal and consumerist systems benefit patients skilled in commanding attention, navigating complex systems, and possessing high health literacy (71). Technological advancements may disadvantage certain patient populations, increasing their distance from general practice support and exacerbating inequality gaps (19). Contemporary policies that shape healthcare access and services often assume that patients present with pre-formed and predetermined problems (72). This overlooks ‘problem-setting’, an essential step in GP-patient interactions for collaborative identification and prioritisation of issues. Active patient participation in problem-setting promotes collaboration with GPs, fostering sustainable care approaches, and reducing feelings of hopelessness, apprehension, and disempowerment (35).

Workload (demand, nature, and quantity) and resource imbalances (e.g. finance, peer, and organisational support), can impede meaningful work (5, 19, 28, 35, 43, 46, 50, 53, 65, 73–77) (CMOC4). When GPs experience consistently high workloads with limited resources and respite, they are at risk of burnout, as they feel out of control and overwhelmed (5, 16, 19, 30, 35, 50, 73–75) (CMOC5). Despite the assumption that remote work enhances efficiency, the transformation from face-to-face to remote consulting can paradoxically increase GP workload due to increased patient access, expectation/demands, and limited opportunities for GPs to schedule breaks and/or time with colleagues (19, 34) (CMOC6).

Numerous studies identify administrative work as problematic (19, 28, 29, 38, 43, 45, 50, 75). It is frequently categorised as ’hidden’ or ‘invisible’, reflecting a lack of allocated, explicit, or scheduled time (in contrast to a hospital consultant who might have a combination of clinical and administrative sessions) (65). Administrative work was more acceptable when it could be attributed meaning, such as when it was requested by the GP, or involved reviewing the results and considering management options for a known patient. When work organisation resulted in GPs seeing fewer patients (e.g. delegated to HCPs) to perform more administrative tasks and/or these tasks became disconnected from known patients, administrative work was perceived as more challenging, risky, and burdensome (36).

However, in contexts where direct human connections and face-to-face interactions with patients and colleagues are present, paperwork/administrative work can be perceived as a means to a larger end and become an accepted part of GP’s work (43, 62).