There are currently not enough GPs in England to meet the rising demand for healthcare services. In response, general practices are employing a broader range of health professionals, such as nurses, pharmacists, and physiotherapists, to do some of the work traditionally done by GPs. However, it remains unclear if and how these changes are helping to manage pressures and how they are impacting patient care. This study will use information contained in health records to understand more about the impact of these changes for both patients and staff. We will use these data to describe how the staffing of general practices across England has changed over the last 8 years and how these changes relate to the level of socioeconomic deprivation in the practice catchment area. We will also look at the number of patients seen by the different staff groups over this period to help us understand how staffing changes have impacted the provision of healthcare services.
General practices in England are currently facing major workforce pressures with falling numbers of full time General Practitioners (GPs) and rising demand for services. One solution has been to change practice skill mix by employing higher numbers of non-medical staff. However, the impact of skill mix change on staff activity and patient outcomes remains unclear. The current study aims to improve understanding of how practice skill mix and consultation patterns have changed over the period 2015 to 2023 and what impact this has had on consultation activity.
We will use the staff identifier held in CPRD Arum patient records to:
1. Describe annual practice-level headcounts and activity for each staff group from 2015 to 2023
2. Assess which combinations of staffing are associated with lower GP activity
3. Examine the association between trends in skill mix, activity, and practice area deprivation
4. Derive a practice-level skill mix metric that can be used to sample practices for a subsequent study looking associations between practice skill mix and patient outcomes
This is a descriptive study that will estimate means, proportions and other summary statistics capturing the distribution of staff groups by practice in England.
The primary outcome of interest is skill mix. This will be measured as:
• Headcount (number) of staff in each staff group that provide a consultation (staff groups are GPs/nurses/healthcare professionals/healthcare associate professionals (Appendix 1))
• Combinations of staff groups will be derived from this (e.g. proportion of staff that are GPs)
A secondary outcome is activity for each staff group. This will be measured as:
• Number of consultations that each staff group provides based on the consultations table
Mai Stafford - Chief Investigator - The Health Foundation
Yannis Kotrotsios - Corresponding Applicant - The Health Foundation
Alexander Lawless - Collaborator - The Health Foundation
Anna Powell - Collaborator - The Health Foundation
Arlene Gallagher - Collaborator - The Health Foundation
Freya Tracey - Collaborator - The Health Foundation
Geraldine Clarke - Collaborator - The Health Foundation
Jake Beech - Collaborator - The Health Foundation
Jay Hughes - Collaborator - The Health Foundation
Toby Watt - Collaborator - The Health Foundation
Nihar Shembavnekar - Collaborator - The Health Foundation
Practice Level Index of Multiple Deprivation