Higher staffing levels in primary care are associated with more appointment provision, but not speed of appointment availability, a new study has found.
The research paper published in the British Journal of General Practice today analysed NHS Digital general practice data from August to October 2022, to identify variations in the workforce and in the number of appointments delivered.
The researchers from the University of Manchester analysed the figures on attended appointments at each practice by staff type (classified as GP or other care professional), and time between booking and appointment, covering 98.7% of practices and 99.8% of all registered patients in England.
While there was evidence of substitution between staff types in appointment provision, the levels of staffing were not associated with proportions of same- or next-day appointments, the paper said.
Dr Rachel Meacock, senior lecturer in health economics at the University of Manchester, told Pulse: ‘We wanted to look at what factors determine appointment provision across practices, so how do population characteristics relate to how many appointments are available, how do workforce characteristics relate to appointment provision.
‘We don’t find that higher levels of staffing per the size of population are associated with lower waiting times for appointment, so it doesn’t seem like practices with more staff of any group per population are able to provide appointments any quicker – and we know that patients not all want appointments on the same or next day, so that might explain it.’
The study also showed that appointment rates per person are higher for practices serving rural areas, and practices serving more deprived populations had more appointments with other care professionals but not GPs.
On average, practices delivered 1,414 appointments per 1,000 registered patients in three months.
Dr Meacock said the findings show that employing more staff of any group might not be the solution to reduce appointment times.
She said: ‘We care about access, we care about the quality of care provided to people once they do access services, and people care about waiting times and speed of appointment. Continuity was also shown to be an important element of quality.
‘Obviously as we widen the workforce and the practice employs more staff, then you are less likely to see the same member of staff if you go to your practice multiple times.
‘Quality is multidimensional and I think that often the policy solutions see it as very simplistic – it’s often said: “We’ll get more staff and that will fix the problem”.
‘And I think we just need to keep in mind there may be some good things about expanding workforce in terms of numbers and in terms of skill set but there might be things that we want to watch out for as well which could be some negative consequences of doing that.’
The paper said: ‘While access is an important dimension of healthcare quality, the safety and effectiveness of care delivered must also be considered.
‘Increasing appointment volumes has come at the cost of reduced continuity. Together these findings mean that caution is needed when pursuing increased access through skill-mix expansion, as this may come at the price of lower quality.’
A Pulse analysis published in January looked at NHS Digital data on GP appointments and showed some correlations between average waiting times and factors such as deprivation scores and their patients per GP. These correlations existed inversely for percentage of appointments that were F2F.
The findings in full
Results
Appointment levels were higher at practices serving rural areas. Practices serving more deprived populations had more appointments with other care professionals but not GPs. One additional full-time equivalent (FTE) GP was associated with an extra 175 appointments over 3 months. Additional FTEs of other staff types were associated with larger differences in appointment rates (367 appointments per additional nurse and 218 appointments per additional other care professional over 3 months). There was evidence of substitution between staff types in appointment provision. Levels of staffing were not associated with proportions of same- or next-day appointments.
Conclusion
Higher staffing levels are associated with more appointment provision, but not speed of appointment availability. New information on activity levels has shown evidence of substitution between GPs and other care professionals in appointment provision and demonstrated additional workload for practices serving deprived and rural areas.
Sadly, in retrospect, we used QOF windfall money to increase appointments almost 20years ago It led to increased demand and seemingly lower satisfaction. We just saw lots more self limiting disease at an earlier stage.
We satisfied demand rather than need.
I would look to systems or nations that do things better than we do. It would not be the US system.
This is mainly because of lack of understanding of how GP and GP appointments systems work.
The vast majority of people needing urgent or same-day appointments are, an always did, get them within a day or so.
Increasingly, though, and especially as more staff become available, we are able to give them MORE APPROPRIATE staff appointments and for linked staff in the near future instead of sending them to hospital-based care. They get to see the Physio quicker, but not on day of asking, beause Physio does not come to GP every day, and has a waiting list.
We also STILL give appointments, and the number of them that we do is increasing due to increasing number of patients with chronic health conditions (a- becasue we are good at keeing them alive; b-because they have been off-loaded from hospital clinics; and c – because government policy to spread covid increases incidence of chronic condition) for their NEXT ANNUAL REVIEW. These appointments may be for review in 6 or 12 months time, but are counted incorrectly as a waiting time of 6 or 12 months to see your GP. Maybe this is not done to every practice, or by every CCG/CQC, but it is certainly done by many, with no effort to differentiate whether patients are needing an urgent appointment, or wating longer for a 6-month review they are booking in advance, which is not a ‘real’ wait.