Does shortage of GPs matter? A cross-sectional study of practice population life expectancy

Abstract

Background: England has insufficient GPs. Access and continuity are declining. Aim: To investigate whether practice characteristics are associated with life expectancy of practice populations. Design and Setting: Cross-sectional ecological study of female and male life expectancy 2015-19. Method: Selection of independent variables was based on conceptual frameworks describing general practice’s influence on outcomes. Sixteen non-correlated variables were entered into multivariable weighted regression models: population characteristics (Index of Multiple Deprivation, region, % white ethnicity, % on diabetes register); practice organisation (total NHS Payments to practices expressed as payment/registered patient, full time equivalent [FTE] fully qualified GPs, trainee GPs, advanced nurse practices, other nurses and receptionists/1000 patients); access (% seen on the same day); clinical performance (% aged 45 or older with BP checked, % with COPD vaccinated against influenza, % with diabetes in glycaemic control, % with CHD on anti-platelet therapy); and the therapeutic relationship (% continuity). Results: Deprivation was strongly negatively associated with life expectancy. Regions outside London, and white ethnicity were associated with lower life expectancy. Higher payment/patient, FTE fully qualified GPs/1000 patients, continuity, % with COPD having influenza vaccination, and % with diabetes with glycaemic control were associated with higher life expectancy; % being seen on same day was associated with higher life expectancy in males only. Percentage 45 years or older with a BP check was a negative predictor in females. Conclusion: The numbers of GPs, continuity, and access are declining, and it is worrying that these features of general practice were positively associated with life expectancy.

Ongoing Decline in Continuity With GPs in English General Practices: A Longitudinal Study Across the COVID-19 Pandemic

“…We excluded variables that did not meet these criteria (Supplemental Table 2). 20 We categorized the included variables as context, population characteristics, practice characteristics, or appointment uptake (influencing access). Where available, we included all 5 years of values for numeric variables.…”

“…26 We sought to include a specific measure of morbidity as an offset; however, our potential morbidity variables correlated highly with other variables. 20 We therefore used IMD, which includes a health component, to reflect morbidity in our model.…”

“…26 Research has supported both the validity and reliability of the GPPS output, 27,[46][47][48] and previous studies have used GPPS data. 20,25,27 Finally, our analysis was ecological, examining longitudinal associations between our variables but not causation.…”

“…LCoC is widely regarded as a key feature of primary care, 5 valued by both clinicians 6 and patients. [7][8][9] Greater LCoC has benefits, [10][11][12][13][14][15][16][17][18][19][20] but also potential harms. 5,[21][22][23][24] The national level of LCoC in England, using a recognized measure (described later), decreased from 27.0% to 16.6% of practice patients between 2018 and 2022.…”