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Primary Care research is part of the Health Sciences Research Group
within the School of Community Based Medicine
Primary Care

Workforce

This programme aims to increase our understanding of how primary care workers can be influenced to locate and configure into teams that improve the accessibility, quality and cost-effectiveness of primary care. Our work is in three main areas:

Team size and composition

Over the last ten years we have undertaken skill-mix reviews, case studies and trials to assess whether shifting care from GPs to other primary care professionals are plausible strategies for improving care and reducing GP workload. We have considered the potential roles of

Alongside this evaluation work we have tracked changes in team size, team composition and work content in practice using the workload diary element of our QUIP study (Quality and Incentives in Practice QuIP). Using these linked patient-practice data we are examining the effect of these changes on patient care, satisfaction and outcomes.

Labour supply and working conditions

The unique data assembled from our national GP Worklife Surveys have enabled studies of working hours, remuneration, job satisfaction, alternative contract options (such as salaried employment), contract reforms, and job preferences. We have undertaken surveys in 1998, 2001, 2004, 2005 and 2008, and have thus been able to look at long term trends in these key aspects of labour supply.   The NHS has been an active recruiter of international medical graduates, with one-third of the doctor workforce having qualified overseas (overseas doctors ). We have also considered overseas labour supply using a database of doctor employment histories (recruitment initiatives).  With international colleagues we are currently undertaking a survey to compare professional values and behaviours across four medical specialties, between fully qualified doctors and doctors in training, and between doctors in different countries.

Geographical distribution 

The theme has also had an enduring focus on the geographical distribution of primary care workers. Using national databases, we have monitored how inequalities in the distribution of primary care resources have changed in England and Wales since 1974.

In addition we have reviewed, designed and evaluated alternative strategies and initiatives to encourage workers to locate in under-served areas. Salaried posts have greatly increased in number and improved the mobility of the GP workforce but salaried GPs are no longer concentrated in deprived areas. For the GMS Formula Review Group we undertook analysis to derive an adjustment to the pay system to compensate GPs for working in poor health, remote and high cost-of-living areas. We are now investigating what types of GPs and nurses - in terms of their background, training and values - have an affinity for working in deprived communities.

Further information

 

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