Have Primary Care Networks Increased Practice-Level Workforce Inequalities?

Problem

In June 2019 Primary Care Networks (PCNs) were established to bring together practices covering 30,000 to 50,000 patients. The Long Term Plan set out to expand primary care recruitment of additional roles including pharmacists, social prescribing link workers, physiotherapists, physician associates, and paramedics. With limited staff in these specific roles available, workforce shortages may disproportionately affect practices and PCNs in more deprived areas. The overall aim of this research is to assess the impact of PCNs on practice-level workforce inequalities and determine which types of PCNs are best or least able to recruit.

Approach

We will assess the trends in practice-level workforce inequalities over time. The Slope Index of Inequality (SII) and Relative Index of Inequality (RII) for GPs, nurses, other clinical staff, and each additional role will be calculated at each quarter from September 2015 to March 2020, with and without adjustment for patient need using the Carr Hill formula. This will allow for an evaluation of whether the introduction of PCNs in 2019 changed or exacerbated these inequality indices. We will then identify broad types of PCNs using Latent Class Analysis (LCA) based on deprivation, rural/urban classification, patient age structure, patient satisfaction and care quality ratings. Finally, each LCA group will be evaluated on the basis of its ability to recruit additional roles throughout the first fiscal year of PCN rollout, from March 2019 to March 2020.

Findings

As the practice-level workforce data for December 2019 and March 2020 have yet to be released, data analysis is still in progress and specifically findings regarding additional roles recruitment is still preliminary. However, emerging findings suggest that, after adjustment, there is an inverse relationship between deprivation and number of paramedics per 10,000 patients, with fewer paramedics employed in more deprived deciles. This trend in inequality appears to be increasing from September 2015 to September 2019. Moreover, for GPs and for clinical staff excluding GPs and nurses, there is similarly an inverse relationship between deprivation decile and workforce. On the contrary, the number of physician associates employed in more deprived areas is relatively higher than in less deprived areas, especially in recent quarters. The inequality indices and trends over time for physiotherapists, pharmacists, social prescribing link workers and nurses are less clear with the workforce data available thus far. Evaluation of the recruitment ability of certain types of PCNs is still in progress as it is dependent on December 2019 and March 2020 workforce data.

Consequences

Policies regarding PCNs should work to limit both workforce and health inequalities, with funding and resources allocated proportionate to need. Reducing health inequalities is a long-term goal of the NHS, but if workforce inequalities continue to increase so will health inequalities.