Inequalities in the distribution of the general practice workforce in England: a practice-level longitudinal analysis

Abstract

BackgroundIn England, demand for primary care services is increasing and GP shortages are widespread. Recently introduced primary care networks (PCNs) aim to expand the use of additional practice-based roles such as physician associates (PAs), pharmacists, paramedics, and others through financial incentives for recruitment of these roles. Inequalities in general practice, including additional roles, have not been examined in recent years, which is a meaningful gap in the literature. Previous research has found that workforce inequalities are associated with health outcome inequalities.AimTo examine recent trends in general practice workforce inequalities.Design & settingA longitudinal study using quarterly General Practice Workforce datasets from 2015–2020 in England.MethodThe slope indices of inequality (SIIs) for GPs, nurses, total direct patient care (DPC) staff, PAs, pharmacists, and paramedics per 10 000 patients were calculated quarterly, and plotted over time, with and without adjustment for patient need.ResultsFewer GPs, total DPC staff, and paramedics per 10 000 patients were employed in more deprived areas. Conversely, more PAs and pharmacists per 10 000 patients were employed in more deprived areas. With the exception of total DPC staff, these observed inequalities widened over time. The unadjusted analysis showed more nurses per 10 000 patients employed in more deprived areas. These values were not significant after adjustment but approached a more equal or pro-poor distribution over time.ConclusionSignificant workforce inequalities exist and are even increasing for several key general practice roles, with workforce shortages disproportionately affecting more deprived areas. Policy solutions are urgently needed to ensure an equitably distributed workforce and reduce health inequities.

Tackling the inverse care law: Analysis of policies to improve general practice in deprived areas since 1990

“…And these gaps may be widening: analysis of data on GP numbers in England from 2015 to 2020 suggest that inequities in the distribution of GPs are growing. 42 Meantime, general practice is in a precarious state. GP consultation numbers are now higher than they were pre-pandemic, 14 but the number of permanent, fully qualified GPs has fallen since 2015.…”

“…By 2020, there were 1.4 fewer full-time equivalent GPs per 10,000 patients in the most deprived areas compared with the most affluent areas. 42 This has not always been the case. Between 2004/05 and 2013/14, the number of GPs working in more deprived areas rose.…”

General and Vulnerable Population’s Satisfaction With the Healthcare System in Urban and Rural Areas: Findings From the European Social Survey

“…Further studies are needed to understand the difference in satisfaction between country villages and country homes, the latter being the area with the lowest level of satisfaction in our multivariable model (Table 2), regardless of the other factors considered. The difference in level of satisfaction may be related to inadequate quality, quantity or distribution of primary care providers [19,43,[58][59][60]; to a greater difficulty in accessing local or tertiary hospitals [61,62]; or to a voluntary reduced use of health care services [42,60,63]. Rural villagers' satisfaction may also be related to the supportive role of small communities [60,61] that may be absent in people who live more isolated.…”

New plan for supporting general practice in England

“…Before covid-19, GP shortages stood at 2500—and could grow to 7000 by 2024 12. GP shortages disproportionately affect more deprived areas,13 which have also been hit hardest by covid-19.…”