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.
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.
| Original language | English |
|---|---|
| Article number | BJGP.2023.0007 |
| Journal | British Journal of General Practice |
| DOIs | |
| Publication status | Published - 4 Jul 2023 |
Keywords
- General Practice
- Health Services Research
- Primary Care
- Workforce
- Inequality
