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Pettigrew LM, Petersen I, Mays N, Cromwell D. The changing shape of English general practice: a retrospective longitudinal study using national datasets describing trends in organisational structure, workforce and recorded appointments. BMJ Open 2024; 14:e081535. [PMID: 39227175 DOI: 10.1136/bmjopen-2023-081535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2024] Open
Abstract
OBJECTIVE To describe trends in the organisational structure, workforce and recorded appointments by role in English general practice. DESIGN Retrospective longitudinal study. SETTING English general practice. DATA SOURCES AND PARTICIPANTS NHS England, Office for Health Improvement and Disparities and Care Quality Commission national administrative datasets covering between 5 to 10 years from 2013 to 2023. RESULTS Between 2013 and 2023, the number of general practices fell by 20% from 8044 to 6419; the average practice list size increase by 40% from 6967 to 9724 patients. The total population covered by providers with over 100 000 registered patients reached 2.3 million in 2023 compared to 0.5 million in 2017. The proportion of practices under individual ownership decreased from 13% to 11% between 2018 and 2023; there was little change in the proportion owned by partnerships, incorporated companies or NHS bodies, which respectively averaged around 80.3%, 6.9% and 0.7%. Between 2015 and 2022, there was a 20% rise in the total full-time equivalent (FTE) general practice workforce, including Primary Care Network staff, from 1.97 to 2.37 per 1000 patients because of an increase in multidisciplinary other 'Direct Patient Care' (DPC) and administrative roles. The number of nurses remained stable, and the number of qualified general practitioners (GPs) decreased by 15%. In September 2022, there were 0.45 FTE qualified GPs per 1000 patients; GPs and other DPC roles, excluding nurses, each represented 19% of the FTE per 1000 patients workforce; administrative roles represented 51%. The general practice workforce is predominantly female. A quarter of GPs qualified overseas. Between 2018 and 2023, there was no clear upward or downward trend in total appointments per 1000 patients with, on average, half provided by GPs. CONCLUSIONS Since 2013, there has been a shift in general practice towards larger practices with more multidisciplinary teams, alongside a reduction in the number of FTE qualified GPs per 1000 patients. We recommend that the impacts of these changes on access, quality and costs are closely monitored.
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Affiliation(s)
- Luisa M Pettigrew
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Irene Petersen
- Research Department of Primary Care and Population Health, University College London, London, UK
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Nicholas Mays
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - David Cromwell
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Anderson ADG, Carswell S, Heath H, Koutsis J, Guitera P. Skin cancer referrals by nonmedical practitioners: a prospective observational study. Clin Exp Dermatol 2024; 49:1048-1051. [PMID: 38549548 DOI: 10.1093/ced/llae115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 08/24/2024]
Abstract
The aim of this study was to investigate the appropriateness of suspected skin cancer referrals made by nonmedical practitioners (NMPs) and compare this with referrals made by local general practitioners (GPs). Data were collected prospectively from patients referred from primary care to a UK hospital dermatology department. The profession of the referrer was ascertained from review of referral letters and direct questioning. Patient records and subsequent histology reports were reviewed to determine the ultimate diagnoses. Eighty-nine per cent of patients (n = 668/753) were referred by GPs vs. 11.3% (n = 85/753) by NMPs. Fifty-one per cent of patients (n = 340/668) in the GP group and 55% (n = 47/85) in the NMP group were discharged without intervention (P = 0.45). An ultimate diagnosis of skin malignancy was made in 196 of 668 (29.3%) patients in the GP and 25 of 85 (29%) patients in the NMP group (P = 0.99). These early data suggest significant potential for NMPs to become more involved in skin lesion assessment.
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Affiliation(s)
- Alexander D G Anderson
- University of Exeter Medical School, The Knowledge Spa, Royal Cornwall Hospital, Truro, UK
- Department of Dermatology, Royal Cornwall Hospitals Trust, Royal Cornwall Hospital, Truro, UK
| | - Sarah Carswell
- Department of Dermatology, Royal Cornwall Hospitals Trust, Royal Cornwall Hospital, Truro, UK
| | - Harry Heath
- Department of Dermatology, Royal Cornwall Hospitals Trust, Royal Cornwall Hospital, Truro, UK
| | - James Koutsis
- Melanoma Institute Australia, Wollstonecraft, NSW, Australia
| | - Pascale Guitera
- Melanoma Institute Australia, Wollstonecraft, NSW, Australia
- Sydney Melanoma Diagnostic Centre, Camperdown NSW, Australia
- University of Sydney Faculty of Medicine and Health, Camperdown, NSW, Australia
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Eriksson M, Blomberg K, Arvidsson E, Van Poel E, Ares-Blanco S, Astier-Peña MP, Collins C, Gabrani J, Stylianou N, Tkachenko V, Willems S. Did the organization of primary care practices during the COVID-19 pandemic influence quality and safety? - an international survey. BMC Health Serv Res 2024; 24:737. [PMID: 38877434 PMCID: PMC11179335 DOI: 10.1186/s12913-024-11173-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Changes in demographics with an older population, the illness panorama with increasing prevalence of non-communicable diseases, and the shift from hospital care to home-based care place demand on primary health care, which requires multiprofessional collaboration and team-based organization of work. The COVID-19 pandemic affected health care in various ways, such as heightened infection control measures, changing work practices, and increased workload. OBJECTIVES This study aimed to investigate the association between primary care practices' organization, and quality and safety changes during the COVID-19 pandemic. DESIGN Data were collected from 38 countries in a large online survey, the PRICOV-19 study. For this paper, the participating practices were categorized as "Only GPs", comprising practices with solely general practitioners (GPs) and/or GP trainees, without any other health care professionals (n = 1,544), and "Multiprofessional," comprising practices with at least one GP or GP trainee and one or more other health professionals (n = 3,936). RESULTS Both categories of practices improved in infection control routines when compared before and during the COVID-19 pandemic. A larger proportion of the multiprofessional practices changed their routines to protect vulnerable patients. Telephone triage was used in more "Multiprofessional" practices, whereas "Only GPs" were more likely to perform video consultations as an alternative to physical visits. Both types of practices reported that the time to review new guidelines and scientific literature decreased during the pandemic. However, both had more meetings to discuss directives than before the pandemic. CONCLUSIONS Multiprofessional teams were keener to introduce changes to the care organization to protect vulnerable patients. However, practices with only GPs were found to be more aligned with video consultations, perhaps reflecting the close patient-doctor relationship. In contrast, telephone triage was used more in multiprofessional teams.
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Affiliation(s)
- Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Eva Arvidsson
- Futurum, Region Jönköping County, Jönköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Maria Pilar Astier-Peña
- Healthcare Quality Territorial Unit, Territorial Health Directorate, Institute of Health of Catalonia, Camp de Tarragona, Barcelona, Spain
| | - Claire Collins
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Irish College of General Practitioners, Dublin, Ireland
| | | | - Neophytos Stylianou
- Department of data analysis, NS Intelligence Solutions Ltd, Nicosia, Cyprus
- Akesis Home Care, Nicosia, Cyprus
| | - Victoria Tkachenko
- Department of Family Medicine, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Kayira AB, Painter H, Mathur R, Ford J. Practice list size, workforce composition and performance in English general practice: a latent profile analysis. BMC PRIMARY CARE 2024; 25:207. [PMID: 38862906 PMCID: PMC11165807 DOI: 10.1186/s12875-024-02462-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Following government calls for General Practices in England to work at scale, some practices have grown in size from traditionally small, General Practitioner (GP)-led organisations to large multidisciplinary enterprises. We assessed the effect of practice list size and workforce composition on practice performance in clinical outcomes and patient experience. METHODS We linked five practice-level datasets in England to obtain a single dataset of practice workforce, list size, proportion of registered patients ≥ 65 years of age, female-male sex ratio, deprivation, rurality, GP contract type, patient experience of care, and Quality and Outcomes Framework (QOF) and non-QOF clinical processes and outcomes. Latent Profile Analysis (LPA) was used to cluster general practices into groups based on practice list size and workforce composition. Bayesian Information Criterion, Akaike Information Criterion and deliberation within the research team were used to determine the most informative number of groups. One-way ANOVA was used to assess how groups differed on indicator variables and other variables of interest. Linear regression was used to assess the association between practice group and practice performance. RESULTS A total of 6024 practices were available for class assignment. We determined that a 3-class grouping provided the most meaningful interpretation; 4494 (74.6%) were classified as 'Small GP-reliant practices', 1400 (23.2%) were labelled 'Medium-size GP-led practices with a multidisciplinary team (MDT) input' and 131 (2.2%) practices were named 'Large multidisciplinary practices'. Small GP-reliant practices outperformed larger multidisciplinary practices on all patient-reported indicators except on confidence and trust where medium-size GP-led practices with MDT input appeared to do better. There was no difference in performance between small GP-reliant practices and larger multidisciplinary practices on QOF incentivised indicators except on asthma reviews where medium-size GP-led practices with MDT input performed worse than smaller GP-reliant practices and immunisation coverage where the same group performed better than smaller GP-reliant practices. For non-incentivised indicators, larger multidisciplinary practices had higher cancer detection rates than small GP-reliant practices. CONCLUSION Small GP-reliant practices were found to provide better patient reported access, continuity of care, experience and satisfaction with care. Larger multidisciplinary practices appeared to have better cancer detection rates but had no effect on other clinical processes and outcomes. As England moves towards larger multidisciplinary practices efforts should be made to preserve good patient experience.
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Affiliation(s)
- Alfred Bornwell Kayira
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, Whitechapel, London, UK.
| | - Helena Painter
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, Whitechapel, London, UK
| | - Rohini Mathur
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, Whitechapel, London, UK
| | - John Ford
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, Whitechapel, London, UK
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Jones B, Anchors Z, Voss S, Walsh N. Challenges and enablers to implementation of the Additional Roles Reimbursement Scheme in primary care: a qualitative study. Br J Gen Pract 2024; 74:e315-e322. [PMID: 38228358 PMCID: PMC11044017 DOI: 10.3399/bjgp.2023.0433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/03/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The Additional Roles Reimbursement Scheme (ARRS) was set up to recruit 26 000 additional staff into general practice by 2024, with the aim of increasing patient access to appointments. Despite the potential benefits of integrating ARRS practitioners into primary care, their implementation has not always been straightforward. AIM To explore the challenges and enablers to implementation of the ARRS including its impact on primary and secondary care systems. DESIGN AND SETTING Qualitative interview study with ARRS healthcare professionals and key professional stakeholders involved in staff education or scheme implementation across three integrated care systems in England. METHOD Participants (n = 37) were interviewed using semi-structured individual or paired interviews. Interviews were audio-recorded and transcribed. Data were analysed using framework analysis until data saturation occurred. RESULTS Using framework analysis, 10 categories were identified. Three were categorised as successes: staff valued but their impact unclear; multiple and certain roles maximise impact; and training hub support. Seven were categorised as challenges: scheme inflexibility; creating a sustainable workforce with career progression; managing scope and expectations; navigating supervision and roadmap progression; infrastructure and integration challenges; ARRS roles impact on wider systems; and tensions and perspectives of existing staff. CONCLUSION Most ARRS staff felt valued, but the scheme broadened expertise available in primary care rather than reducing GP burden, which was originally anticipated. Some PCNs, especially those in areas of high deprivation, found it difficult to meet the population's needs as a result of the scheme's inflexibility, potentially leading to greater health inequalities in primary care. Recommendations are proposed to optimise the effective implementation of the primary care workforce model. Further research is required to explore administrative role solutions, further understand the impact of health inequalities, and investigate the wellbeing of ARRS staff.
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Affiliation(s)
- Bethan Jones
- Centre for Health and Clinical Research, University of the West of England Bristol, Bristol
| | - Zoe Anchors
- Centre for Health and Clinical Research, University of the West of England Bristol, Bristol
| | - Sarah Voss
- Centre for Health and Clinical Research, University of the West of England Bristol, Bristol
| | - Nicola Walsh
- Centre for Health and Clinical Research, University of the West of England Bristol; National Institute for Health and Care Research Applied Research Collaboration West, Bristol
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Abrams R, Jones B, Campbell J, de Lusignan S, Peckham S, Gage H. The effect of general practice team composition and climate on staff and patient experiences: a systematic review. BJGP Open 2024; 8:BJGPO.2023.0111. [PMID: 37827584 PMCID: PMC11169989 DOI: 10.3399/bjgpo.2023.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Recent policy initiatives seeking to address the workforce crisis in general practice have promoted greater multidisciplinarity. Evidence is lacking on how changes in staffing and the relational climate in practice teams affect the experiences of staff and patients. AIM To synthesise evidence on how the composition of the practice workforce and team climate affect staff job satisfaction and burnout, and the processes and quality of care for patients. DESIGN & SETTING A systematic literature review of international evidence. METHOD Four different searches were carried out using MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, and Web of Science. Evidence from English language articles from 2012-2022 was identified, with no restriction on study design. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and data were synthesised thematically. RESULTS In total, 11 studies in primary healthcare settings were included, 10 from US integrated healthcare systems, one from Canada. Findings indicated that when teams are understaffed and work environments are stressful, patient care and staff wellbeing suffer. However, a good relational climate can buffer against burnout and protect patient care quality in situations of high workload. Good team dynamics and stable team membership are important for patient care coordination and job satisfaction. Female physicians are at greater risk of burnout. CONCLUSION Evidence regarding team composition and team climate in relation to staff and patient outcomes in general practice remains limited. Challenges exist when drawing conclusions across different team compositions and definitions of team climate. Further research is needed to explore the conditions that generate a 'good' climate.
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Affiliation(s)
- Ruth Abrams
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Bridget Jones
- Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - John Campbell
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stephen Peckham
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Heather Gage
- Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
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Salant N, Massou E, Awan H, Ford JA. Does workforce explain the relationship between funding and patient experience? A mediation analysis of primary care data in England. BMJ Open 2024; 14:e072498. [PMID: 38373863 PMCID: PMC10882355 DOI: 10.1136/bmjopen-2023-072498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES To determine whether general practitioner (GP) workforce contributes to the link between practice funding and patient experience. Specifically, to determine whether increased practice funding is associated with better patient experience, and to what degree an increase in workforce accounts for this relationship. SETTING Primary care practice level analysis of workforce, funding and patient experience of all NHS practices in England. PRIMARY AND SECONDARY OUTCOME MEASURES The link between NHS-provided funding to general practice (payments per patient) and patient experience, as per the General Practice Patient Survey, was evaluated. Subsequently, mediation analysis, adjusted for covariates, was used to scrutinise the extent to which GP workforce accounts for this relationship (measured as the number of GPs per 10 000 patients). PARTICIPANTS We included all general practices in England for which there was relevant data for each primary variable. Atypical practices were excluded, such as those with a patient list size of 0 or where the workforce variable was recorded as being more than 3 SD from the mean. After exclusion, 6139 practices were included in the final analysis. RESULTS We found that workforce (GPs per 10 000 population) significantly (p<0.001) acts as a mediator in the effect of practice funding on overall patient experience even after adjusting for rurality, sex and age, and deprivation. On average, the mediated effect constitutes 30% of the total effect of practice funding on patient experience. CONCLUSIONS The increase in the number of doctors in primary care in England appears to be a mechanism through which augmented practice funding could positively impact patient experience. Policy initiatives targeting improved patient experience should prioritise considerations related to workforce and practice funding.
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Affiliation(s)
- Natasha Salant
- Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Efthalia Massou
- Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Donaghy E, Huang H, Henderson D, Wang HH, Guthrie B, Mercer SW. Primary care transformation in Scotland: a qualitative study of GPs' and multidisciplinary team members' views. Br J Gen Pract 2024; 74:e1-e8. [PMID: 38154939 PMCID: PMC10756001 DOI: 10.3399/bjgp.2023.0086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/05/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND The Scottish Government's vision to transform primary care includes expansion of the primary care multidisciplinary team (MDT), formalised in the new GP contract in April 2018. AIM To explore practitioners' views on the expansion of MDT working in Scotland. DESIGN AND SETTING Qualitative study with GPs and a range of MDT staff working in three different population settings in Scotland. METHOD In-depth semi-structured interviews were carried out by telephone with 8 GPs and 19 MDT staff between May and June 2022. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted to identify commonalities and divergences in the interviews. RESULTS Internal challenges facing MDT staff included adapting to the fast pace of primary care, building new relationships, training and professional development needs, line management issues, and monitoring and evaluation of performance. External challenges included the ongoing effects of the COVID-19 pandemic, lack of time, difficulties with hybrid working, and low staff morale. Most GPs reported that expansion of their roles as expert medical specialists had not yet happened because their workload had not decreased (and in many cases had increased). In deprived areas, insufficient resources to deal with the high numbers of patients with complex multimorbidity remained a key issue. Interviewees in remote and rural settings felt the new contract did not take into account the unique challenges of providing primary care services in such areas, and recruitment and accommodation were cited as particular problems. CONCLUSION Although there has been substantial expansion of the primary care MDT, which most GPs welcome, many challenges to effective implementation remain that must be addressed if transformation of primary care in Scotland is to become a reality.
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Affiliation(s)
- Eddie Donaghy
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Huayi Huang
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - David Henderson
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Harry Hx Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Bruce Guthrie
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Stewart W Mercer
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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Cassou M, Mousquès J, Franc C. General Practitioners activity patterns: the medium-term impacts of Primary Care Teams in France. Health Policy 2023; 136:104868. [PMID: 37567092 DOI: 10.1016/j.healthpol.2023.104868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/27/2023] [Accepted: 06/30/2023] [Indexed: 08/13/2023]
Abstract
Faced with the fragmentation of the French primary care system, public policies aim to promote multiprofessional teamwork to improve both delivery efficiency and health professionals' working conditions. Thus, a practice-level add-on payment backed by cooperation commitments is implemented to foster and sustain the development of multiprofessional primary care groups (MPCGs). We study the impact of practising in MPCGs for general practitioners (GPs) in terms of the supply of care, practice patterns and income. Based on this quasiexperimental framework with a panel dataset covering the period 2005-2017, we account for the selection into MPCGs by combining a difference-in-differences design with propensity score matching to prebalance samples. We show that GPs in MPCGs increased their patient list more rapidly than control GPs (+10% increase of encountered patients) without increasing their provision of services (number of visits and drug prescriptions) more rapidly. Instead, compared to control GPs, MPCG GPs had a significantly faster reduction in the average number of visits (+5.5% reduction) and the euro-amounts of drug prescriptions per patient (+7.2% reduction) and other prescriptions. The growth of these effects between the short and medium term moreover suggests that the properties of multi-professional coordination and cooperation need time to develop.
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Affiliation(s)
- Matthieu Cassou
- Institute for Research and Information in Health Economics, (IRDES), 21 rue des Ardennes 75019 Paris, France.
| | - Julien Mousquès
- Institute for Research and Information in Health Economics, (IRDES), 21 rue des Ardennes 75019 Paris, France; EHESP, SHS department, ARENES - UMR 6051, 15 Av. du Professeur Léon Bernard, 35043 Rennes, France.
| | - Carine Franc
- Institute for Research and Information in Health Economics, (IRDES), 21 rue des Ardennes 75019 Paris, France; Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research, (INSERM U1018), Université Paris-Saclay, Université, Paris-Sud, UVSQ, 16 Avenue Paul Vaillant Couturier, 94807 Cedex Villejuif, France.
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Zhao T, Meacock R, Sutton M. Population, workforce, and organisational characteristics affecting appointment rates: a retrospective cross-sectional analysis in primary care. Br J Gen Pract 2023; 73:e644-e650. [PMID: 37604698 PMCID: PMC10471139 DOI: 10.3399/bjgp.2022.0625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/22/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The recent publication of data on appointment volumes for all general practices in England has enabled representative analysis of factors affecting appointment activity rates for the first time. AIM To identify population, workforce, and organisational predictors of practice variations in appointment volume. DESIGN AND SETTING A multivariable cross-sectional regression analysis of 6284 general practices in England was undertaken using data from August-October 2022. METHOD Multivariable regression analyses was conducted. It related population age and deprivation, numbers of GPs, nurses, and other care professionals, and organisation characteristics to numbers of appointments by staff type and to proportions of appointments on the same or next day after booking. RESULTS Appointment levels were higher at practices serving rural areas. Practices serving more deprived populations had more appointments with other care professionals but not GPs. One additional full-time equivalent (FTE) GP was associated with an extra 175 appointments over 3 months. Additional FTEs of other staff types were associated with larger differences in appointment rates (367 appointments per additional nurse and 218 appointments per additional other care professional over 3 months). There was evidence of substitution between staff types in appointment provision. Levels of staffing were not associated with proportions of same-or next-day appointments. CONCLUSION Higher staffing levels are associated with more appointment provision, but not speed of appointment availability. New information on activity levels has shown evidence of substitution between GPs and other care professionals in appointment provision and demonstrated additional workload for practices serving deprived and rural areas.
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Affiliation(s)
- Tianchang Zhao
- Policy and Economics, School of Health Sciences, University of Manchester, Manchester
| | - Rachel Meacock
- Policy and Economics, School of Health Sciences, University of Manchester, Manchester
| | - Matt Sutton
- Policy and Economics, School of Health Sciences, University of Manchester, Manchester
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Ladds E, Greenhalgh T. Modernising continuity: a new conceptual framework. Br J Gen Pract 2023; 73:246-248. [PMID: 37230773 PMCID: PMC10229150 DOI: 10.3399/bjgp23x732897] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Trish Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
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12
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Granja M, Correia S, Alves L. Access to General Practitioners during the second year of the COVID-19 pandemic in Portugal: a nationwide survey of doctors. BMC PRIMARY CARE 2023; 24:46. [PMID: 36782109 PMCID: PMC9924884 DOI: 10.1186/s12875-023-01994-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND The Portuguese National Health System (NHS) provides universal coverage and near-free health care, but the population has high out-of-pocket expenses and unmet care needs. This suggests impaired accessibility, a key dimension of primary care. The COVID-19 pandemic has further affected access to health care. Understanding General Practitioners' (GP) experiences during the pandemic is necessary to reconfigure post-pandemic service delivery and to plan for future emergencies. This study aimed to assess accessibility to GPs, from their perspective, evaluating determinants of accessibility during the second pandemic year in Portugal. METHODS All GPs working in NHS Family Practices in continental Portugal were invited to participate in a survey in 2021. A structured online self-administered anonymous questionnaire was used. Accessibility was assessed through waiting times for consultations and remote contacts and provision of remote access. NHS standards were used to assess waiting times. Descriptive statistics were used to characterize the study sample. Associations between categorical variables were tested using the χ2 statistic and the Student t-test was used to compare means of continuous variables. RESULTS A total of 420 GPs were included (7% of the target population). Median weekly working hours was 49.0 h (interquartile range 42.0-56.8), although only 14% reported a contracted weekly schedule over 40 h. Access to in-person consultations and remote contacts was reported by most GPs to occur within NHS time standards. Younger GPs more often reported waiting times over these standards. Most GPs considered that they do not have enough time for non-urgent consultations or for remote contacts with patients. CONCLUSIONS Most GPs reported compliance with standards for waiting times for most in-person consultations and remote contacts, but they do so at the expense of work overload. A persistent excess of regular and unpaid working hours by GPs needs confirmation. If unpaid overtime is necessary to meet the regular demands of work, then workload and specific allocated tasks warrant review. Future research should focus on younger GPs, as they seem vulnerable to restricted accessibility. GPs' preferences for more in-person care than was feasible during the pandemic must be considered when planning for the post-pandemic reconfiguration of service delivery.
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Affiliation(s)
- Mónica Granja
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal.
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal.
| | - Sofia Correia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
| | - Luís Alves
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
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Spooner S, McDermott I, Goff M, Hodgson D, McBride A, Checkland K. Processes supporting effective skill-mix implementation in general practice: A qualitative study. J Health Serv Res Policy 2022; 27:269-277. [PMID: 35503531 PMCID: PMC9548943 DOI: 10.1177/13558196221091356] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objectives Health policy and funding initiatives have addressed increasing workloads in
general practice through the deployment of clinicians from different
disciplinary backgrounds. This study examines how general practices in
England operate with increasingly diverse groups of practitioners. Methods Five general practices were selected for maximum variation of the duration
and diversity of skill-mix in their workforce. Individual interviews were
recorded with management and administrative staff and different types of
practitioner. Patient surveys and focus groups gathered patients’
perspectives of consulting with different practitioners. Researchers
collaborated during coding and thematic analysis of transcripts of audio
recordings. Results The introduction of a wide range of practitioners required significant
changes in how practices dealt with patients requesting treatment, and these
changes were not necessarily straightforward. The matching of patients with
practitioners required effective categorization of health care patients’
reported problem(s) and an understanding of practitioners’ capabilities. We
identified individual and organizational responses that could minimize the
impact on patients, practitioners and practices of imperfections in the
matching process. Conclusions The processes underpinning the redistribution of tasks from GPs to non-GP
practitioners are complex. As practitioner employment under the Primary Care
Network contracts continues to increase, it is not clear how the necessarily
fine-grained adjustments will be made for practitioners working across
multiple practices.
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Affiliation(s)
- Sharon Spooner
- Centre for Primary Care Research, 5292University of Manchester, UK
| | - Imelda McDermott
- Centre for Primary Care Research, 5292University of Manchester, UK
| | - Mhorag Goff
- Centre for Primary Care Research, 5292University of Manchester, UK
| | | | - Anne McBride
- Alliance Manchester Business School, 5292University of Manchester, UK
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Forde E, Collins K. GPs' understanding of the wider workforce in primary care. Br J Gen Pract 2022; 72:214. [PMID: 35483957 PMCID: PMC11189038 DOI: 10.3399/bjgp22x719273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Emer Forde
- HEE Thames Valley and Wessex Primary Care School.
| | - Katie Collins
- HEE Thames Valley and Wessex Primary Care School; Clinical Lead, Hampshire and Isle of Wight New to Practice GP Fellowship Programme
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