Abstract
BackgroundIn England, demand for primary care services is increasing and GP shortages are widespread. Recently introduced primary care networks (PCNs) aim to expand the use of additional practice-based roles such as physician associates (PAs), pharmacists, paramedics, and others through financial incentives for recruitment of these roles. Inequalities in general practice, including additional roles, have not been examined in recent years, which is a meaningful gap in the literature. Previous research has found that workforce inequalities are associated with health outcome inequalities.AimTo examine recent trends in general practice workforce inequalities.Design & settingA longitudinal study using quarterly General Practice Workforce datasets from 2015–2020 in England.MethodThe slope indices of inequality (SIIs) for GPs, nurses, total direct patient care (DPC) staff, PAs, pharmacists, and paramedics per 10 000 patients were calculated quarterly, and plotted over time, with and without adjustment for patient need.ResultsFewer GPs, total DPC staff, and paramedics per 10 000 patients were employed in more deprived areas. Conversely, more PAs and pharmacists per 10 000 patients were employed in more deprived areas. With the exception of total DPC staff, these observed inequalities widened over time. The unadjusted analysis showed more nurses per 10 000 patients employed in more deprived areas. These values were not significant after adjustment but approached a more equal or pro-poor distribution over time.ConclusionSignificant workforce inequalities exist and are even increasing for several key general practice roles, with workforce shortages disproportionately affecting more deprived areas. Policy solutions are urgently needed to ensure an equitably distributed workforce and reduce health inequities.
Highlights
Fewer GPs, total direct patient care (DPC) staff, and paramedics per 10 000 patients were employed in more deprived areas
The composition of the general practice workforce is changing with the introduction of primary care networks (PCNs)
It is found that significant workforce inequalities exist and are even increasing for several key general practice roles, with workforce shortages disproportionately affecting more deprived areas
Summary
Especially in primary care, have long plagued healthcare systems globally, and the gap between the growing need for services and sufficient staff has been widening.[1,2,3,4,5,6,7] The number of consultations in general practice has increased significantly in recent years, but staff numbers have not kept up with this demand.[5,6,8,9,10,11,12] The percentage of GPs in the NHS workforce has been steadily decreasing, and the GP workforce is ageing; doctors are increasingly working part-time, which foreshadows future worsening shortages.[5,6,8,12,13] In 2015, -Secretary of State for Health Jeremy Hunt promised an additional 5000 GPs for the NHS by 2020, but this was not achieved; instead, it is predicted that there will be a shortage of 7000 GPs by 2024.5,14 England’s increasingly depleted primary care workforce will likely be a 'make-or-break' issue for the NHS in coming years.[5]. Introduced primary care networks (PCNs) aim to expand the use of additional practice-based roles such as physician associates (PAs), pharmacists, paramedics, and others through financial incentives for recruitment of these roles. Previous research has found that workforce inequalities are associated with health outcome inequalities
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