How new clinical roles in primary care impact on equitable distribution of workforce: a retrospective study

Abstract

Background: There are inequalities in the geographical distribution of the primary care workforce in England. Primary Care Networks (PCNs), and the associated Additional Roles Reimbursement Scheme (ARRS) funding, has stimulated employment of new healthcare roles. However, it is not clear whether this will impact inequalities. Aim: To examine whether the ARRS impacted inequality in the distribution of primary care workforce. Design and Setting: A retrospective before-and-after study of English PCNs in 2019 and 2022 Methods: We combined workforce, population and deprivation data at network-level for March 2019 and March 2022. We estimated the change between 2019 and 2022 in the Slope Index of Inequality (SII) across deprivation of full-time equivalent general practitioners (total doctors, qualified GPs and doctors-in-training), nurses, other direct patient care (ARRS and non-ARRS staff), administrative, and total staff per 10,000 patients. Results: 1255 networks were included. Nurses and qualified GPs decreased in number whilst all other staff roles increased, with ARRS staff having the greatest increase. There was a pro-rich change in the SII for administrative staff (-0.482 (95% CI: -0.841, -0.122)) and a pro-poor change for doctors-in-training (0.161 (0.049, 0.274)). Changes in distribution of all other staff types were not statistically significant. Conclusion: The distribution of administrative staff became less pro-poor and of doctors-in-training became pro-poor between 2019 and 2022. The changes in inequality in all other staff groups were mixed. The introduction of PCNs has not substantially changed the longstanding inequalities in the geographical distribution of primary care workforce.

Geographic inequalities in need and provision of social prescribing link workers a retrospective study in primary care

“…Our findings support the notion that the availability of healthcare is inversely related to need (10) and that despite funding being adjusted for age and deprivation (11), this may not address these issues. We find comparable results with Hutchinson et al (12) who found that PCN staffing has not reduced deprivation-related inequality which could be linked to capacity to recruit and/or ability to attract them to work in the local area. This is demonstrated geographically with areas of the South East and North West of England having low uptake of link workers across the study period.…”

“…Despite the funding for social prescribing being adjusted for deprivation 11 and the 2022 mandate, 5 the current study’s findings indicate that this may not be the case and supports past research that PCNs have not changed the inequalities across England. 12 Pre-existing health inequalities may be exacerbated by an inequitable distribution in the primary care workforce as a consequence. 27 , 28 …”

“…To assess need, we use data from the General Practice Patient Survey(19) (GPPS) from January to March 2019, before the start of the national programme to employ link workers for social prescribing. We use the proportion of people with at least one (self-reported) long-term condition who responded "No" (rather than "Yes -definitely", "Yes -to some extent" or "Don't know/Can't Say") to the following question: "In the last 12…”

“…PCN social prescribing link workers are employed through the additional roles reimbursement scheme (ARRS). This enables PCNs to recruit additional roles to help increase access for patients, but Hutchinson et al (12) has shown that overall, the scheme had not reduced deprivation-related inequality in staffing by 2022.…”