Primary care workforce composition and population, professional, and system outcomes: a retrospective cross-sectional analysis.
efficiency
job satisfaction
primary care
quality
skill-mix
workforce
Journal
The British journal of general practice : the journal of the Royal College of General Practitioners
ISSN: 1478-5242
Titre abrégé: Br J Gen Pract
Pays: England
ID NLM: 9005323
Informations de publication
Date de publication:
05 2022
05 2022
Historique:
received:
28
10
2021
accepted:
17
01
2022
pubmed:
6
4
2022
medline:
3
5
2022
entrez:
5
4
2022
Statut:
epublish
Résumé
The diversification of types of staff delivering primary care may affect professional, population, and system outcomes. To estimate associations between workforce composition and outcomes. Cross-sectional analysis of 6210 GP practices from a range of geographical settings across England in 2019. A multivariable regression analysis was undertaken, relating numbers of staff in four groups - GPs, nurses, healthcare professionals, and health associate professionals - to patient access and satisfaction, quality of clinical care and prescribing, use of hospital services, GP working conditions (subsample of practices), and costs to the NHS. Data were obtained from the GP Patient Survey 2019, Quality and Outcomes Framework, prescribing data, the Hospital Episode Statistics database, the NHS Payments to General Practice 2019/2020, and the Having additional GPs was associated with higher levels of satisfaction for the GPs themselves and for patients, whereas additional staff of other types had opposite associations with these outcomes. Having additional nurses and health associate professionals was associated with lower costs per prescription but more prescribing activity than having additional staff from the other two groups. Having more GPs was associated with higher costs per prescription and lower use of narrow-spectrum antibiotics compared with the other staff groups. Except for health associate professionals, greater staff numbers were associated with more hospital activity. Professional, population, and system outcomes showed a variety of associations with primary care workforce composition. Having additional nurses was associated with lower quality in some aspects, and higher costs and activity. The association between additional healthcare professionals or health associate professionals and higher costs was less than that for additional GPs, but was also linked to lower patient and GP satisfaction.
Sections du résumé
BACKGROUND
The diversification of types of staff delivering primary care may affect professional, population, and system outcomes.
AIM
To estimate associations between workforce composition and outcomes.
DESIGN AND SETTING
Cross-sectional analysis of 6210 GP practices from a range of geographical settings across England in 2019.
METHOD
A multivariable regression analysis was undertaken, relating numbers of staff in four groups - GPs, nurses, healthcare professionals, and health associate professionals - to patient access and satisfaction, quality of clinical care and prescribing, use of hospital services, GP working conditions (subsample of practices), and costs to the NHS. Data were obtained from the GP Patient Survey 2019, Quality and Outcomes Framework, prescribing data, the Hospital Episode Statistics database, the NHS Payments to General Practice 2019/2020, and the
RESULTS
Having additional GPs was associated with higher levels of satisfaction for the GPs themselves and for patients, whereas additional staff of other types had opposite associations with these outcomes. Having additional nurses and health associate professionals was associated with lower costs per prescription but more prescribing activity than having additional staff from the other two groups. Having more GPs was associated with higher costs per prescription and lower use of narrow-spectrum antibiotics compared with the other staff groups. Except for health associate professionals, greater staff numbers were associated with more hospital activity.
CONCLUSION
Professional, population, and system outcomes showed a variety of associations with primary care workforce composition. Having additional nurses was associated with lower quality in some aspects, and higher costs and activity. The association between additional healthcare professionals or health associate professionals and higher costs was less than that for additional GPs, but was also linked to lower patient and GP satisfaction.
Identifiants
pubmed: 35379602
pii: BJGP.2021.0593
doi: 10.3399/BJGP.2021.0593
pmc: PMC8999710
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e307-e315Commentaires et corrections
Type : CommentIn
Informations de copyright
© The Authors.