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Service designSep 2, 2022

Doubts raised over bid to boost numbers of physios and other workers in GP practices in England

Satisfaction rates appear to fall when patients are seen by healthcare professionals such as physiotherapists rather than GPs in general practice settings, according to a study funded by the National Institute for Health and Care Research (NIHR).

At team led by Igor Francetic, from Centre for Primary Care and Health Services Research, Health Organisation, Policy and Economics Group at the University of Manchester, analysed data from 6,296 general practices in England from 2015 to 2019.

The NIHR said the study was the most detailed one of its type to be published so far. It explores what effect the rising number of physiotherapists, social prescribers, clinical pharmacists, paramedics and physician associates, among others, in GP practices has had on service delivery and patients’ experiences.

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New roles for professionals and associates was supposed alleviate GPs' workloads

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The study, published in the September issue of Social Science and Medicine, sheds light on the NHS’s bid to boost provision in practices to tackle a shortfall in the numbers of GPs and nurses. Until now, there has been limited evidence on how the policy has affected outcomes.

Physios placed in 'healthcare professionals' group

Dr Francetic and his colleagues explored the statistical relationship between the composition of the workforce and 10 indicators of accessibility, clinical effectiveness, user experiences and health system costs.

We provide substantial evidence of detrimental effects on patient satisfaction when some Health Professionals and Healthcare Associate Professionals are employed. Patient satisfaction is a crucial dimension of quality of care ... [Igor Francetic et al.]

The researchers grouped roles into four categories: GPs, nurses, healthcare professionals and healthcare associate professionals. Healthcare professionals (HPs) included physiotherapists, clinical pharmacists, physician associates, paramedics, podiatrists, counsellors and occupational therapists. Dispensers, healthcare assistants, nurse associates, pharmacy technicians, psychological wellbeing practitioners and social prescribing link workers were grouped into the health associate professional (HAP) group.

Employment levels increased over time for all the staff groups, with largest increases being logged among healthcare professionals, whose numbers rose from an average of 0.04 full time equivalent (FTE) per practice in 2015 to 0.28 in 2019. The smallest increase occurred among nurses, who experienced a 3.5 per cent growth rate.

Boosting GP and nurse numbers had 'positive association'

It emerged that employing more staff in traditional primary care roles, such as GPs and nurses, was positively associated with changes in practice activity and outcomes. Patient satisfaction with primary care services showed a negative trend over the study period. The study found this drop in satisfaction to be larger in practices that had employed more HPs. 

On average, a one FTE increase in HP staff employed at GP practices was associated with a 2.4 percent drop in overall patient satisfaction, which is roughly equivalent in magnitude to the overall decrease observed from 2015 to 2019. Similarly, a one FTE increase in HP levels was associated with a 1.3 percent drop in patient satisfaction with making an appointment, about a quarter of the overall decrease of 7.2 percent.

Interestingly, pharmacists made a positive contribution with regards to some tasks, such improving the quality of medicine prescription and reducing the burden of these activities on existing staff members.

Patient satisfaction levels are 'crucial'

Lead author Igor Francetic said that the introduction of new roles to support GPs does not have straightforward effects on service quality or patient satisfaction. ‘In fact we provide substantial evidence of detrimental effects on patient satisfaction when some health professionals and healthcare associate professionals are employed.'

Dr Francetic added: 'Patient satisfaction is a crucial dimension of quality of care, as it contributes to individuals’ willingness to seek care through GPs.’

To find out more about the NIHR Health and Social Care Delivery Research Programme, visit: https://www.nihr.ac.uk/explore-nihr/funding-programmes/health-and-social-care-delivery-research.htm 

To access the full version of the article, titled Skill-mix change and outcomes in primary care: Longitudinal analysis of general practices in England 2015–2019, visit: https://www.sciencedirect.com/science/article/pii/S0277953622005305#!

Author: Ian A McMillan
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