Increased staffing in primary care ‘unlikely to reduce waiting times’

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 this week 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 our sister publication 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.’

This article was first published by our sister publication Pulse