The nurses were generally satisfied with their job in which they performed various tasks delegated by the GPs. In the nurses’ perspective, this satisfaction was mainly due to the autonomy they enjoyed following the new way of working. However, they experienced an increase in workload and did not feel appreciated for their extra efforts and responsibilities, neither financially, nor in terms of advancement or involvement in decision-making.
Contrary to the nurses, the GPs’ job satisfaction was not increased due to the delegation of tasks to the staff. They experienced a loss of continuity of care threatening their professional identity as providers of holistic care, and they were burdened by an increase in workload due to their new supervisor role.
The results of the included papers regarding the predominant theme, autonomy, are consistent with results of studies conducted among staffs in other clinical settings. Hence, studies across various settings such as the home care environment  and different hospital settings [34, 35] have shown that autonomy is one of the most important aspects of the job leading to staff job satisfaction.
Another study explored the experiences and clinical challenges that nurses and nursing assistants face in municipal health service in primary care settings when providing high-quality diabetes care for elderly people . It found that good communication with more experienced health care professionals and access to the right information is particularly important to the staff’s confidence and autonomy in order to make clinical decisions, and that the lack of it was contributory to their experience of not being able to care adequately for the patients. Hence professional development and teamwork were related to the staff’s confidence and experience of autonomy, which they perceived as influencing their provision of high-quality care.
Autonomy being a common theme is in line with existing theory on work motivation. Hackman and Oldham  developed a job characteristic model in which certain features of a job could be used as tools for motivating employees as well as for diagnosing existing working conditions. It was tested using data from 658 employees, both blue collar and white collar workers, in seven different business organisations.
The model consisted of five core job dimensions leading to three critical psychological states each contributing to desired personal and work-related outcomes. The five core job dimensions were skill variety, task identity, task significance, autonomy, and feedback. Skill variety, task identity, and task significance together lead to the critical psychological state of meaningfulness of work, autonomy leads to the experienced responsibility for outcomes of the work, and feedback is the only way an employee can obtain knowledge of how well he or she is performing in the job. Each psychological state contributes to high internal work motivation, high quality work performance, high satisfaction with the job, and low absenteeism and turnover .
According to the reframing of the model by Dag Ingvar and Jan Thorsvik , delegating tasks is a structural feature of an organisation which is characterised by the core job dimension autonomy leading to a critical psychological state of experienced responsibility for outcomes of the work. According to this, task delegation and job satisfaction appear to be interrelated.
In this way, the results of our review seem to support the model by Hackman and Oldham , but they do not report on the relative significance of each of the core job dimensions. They solely conclude that the self-generated motivation prompted by the core job dimensions in the model should be highest when all three of the psychological states are present.
However, being a recurring theme in all of the four included papers and in studies conducted in other healthcare settings, autonomy appears to be an essential factor in the job satisfaction of the staff. This relation is not surprising since autonomy allows the individual to influence its own work. Still, autonomy is a subjective phenomenon which differs according to the variation in the individual’s perception of freedom and need for growth in the work .
The four included papers varied widely in the methodology and aspects of care, which made it difficult to compare the results. However, the narrative approach used in the review enabled us to explore the views and attitudes of nurses and GPs across these highly different studies even though it did not allow us to standardise the information gained from literature. Yet, by tabulating the evidence in combination with qualitative interpretations of the findings in the form of common themes, we explicated the process from interpretation of the findings towards creation of a synthesis.
A major weakness of the study was that the number of included articles was very small, and therefore, the findings should be interpreted with caution. It is possible that a larger sample would have shown different patterns in the results. Regarding GPs, we only found one paper exploring the relation between task delegation and job satisfaction, hence making it impossible to establish any syntheses on this relation. The language limitation in the study may have influenced the sample size and thereby the studies included. However, since we were interested in international peer-reviewed journals, the vast majority of relevant studies would be in English. We added Scandinavian languages to our search strategy since all of the authors are able to read it and thereby exploring if there were any local studies. However, it did not add any results.
Interpretation of evidence
Quality of care is essential to the patients and should be taken into consideration when organising general practice. Previous studies have identified medical quality of care and patient satisfaction as important quality parameters, and both have been reviewed in relation to task delegation. Even though job satisfaction has proved to be associated with quality of care, relatively few studies are concerned with this suggested relation.
This review found that task delegation promotes the practice staff’s job satisfaction, and that the reason for this relation first and foremost should be attributed to their experienced autonomy following this new way of working. The study also found that recognition for increased responsibilities should be addressed as well when delegating work to the staff. The validity and credibility of these results were, however, limited by the sample size, and therefore, no final conclusions could be drawn from it.
Moreover, since Hackman and Oldham’s model was tested among employees on various levels in a number of business organisations, it is not necessarily transmissible to the setting of general practice. Therefore, to capture a model which is able to explore the working conditions in general practice, for example how task delegation influences the job satisfaction of GPs and their staff, we need to develop it in this context.