How general practice team composition and climate relate to quality, effectiveness and human resource costs: a mixed methods study in England (GP Teams)
A study to help Practices understand the workforce composition, roles and relationships that promote effective and efficient care. The aim of the study it to provide new insights to enable managers to develop innovative appproaches to addressing workforce issues in GP led primary care with a focus on:
- how workforce decisions are made
- how particular staff mixes have developed
- how different roles contribute to practice work and patient care
- what enables staff to work more effetively together
Background and Rationale
The British National Health Service (NHS) is a primary care led system with general practitioners (GPs) being the first point of contact for citizens with non-emergency health care needs. GPs have traditionally worked in practices, led by partners (or a sole partner), employing a team of staff (nurses, care assistants, receptionists, managers) and liaising with other community services. They coordinate care for local people who register with their practice.
The sector faces financial and other pressures that threaten the patient experience. Increases in the number of older people, more lifestyle-related conditions, rising expectations and transfer of some tasks previously undertaken in hospitals to primary care have added significantly to the general practice workload.
Simultaneously, recruitment and retention problems have reduced the number of GPs per capita, and shortages of primary and community nurses have exacerbated staffing problems.
The number of qualifying doctors choosing general practice has gradually declined over the last decade, whilst increasing numbers of GPs have left practice, with many opting to work abroad. Concerns about recruitment and retention have coincided with a period of rapid change in the organisation of general practice. Over time, practices have become larger and incorporated a wider range of staff. In September 2016, the BMA reported 7,613 GP practices in England, a decline of 8% since 2006.
Recently, new organisational forms (e.g. ‘super-practices’, federations, and integrated models of primary and community-based care), and different ownership and contractual models (e.g. Alternative Provider Medical Services) of general practice have developed. The Covid-19 pandemic created new challenges for general practices, disrupting usual working and forcing practices to adopt remote methods of consultation. In this challenging and changing situation, research is required to produce evidence that will enable primary care commissioners and GP practice managers to make resource allocation decisions that will ensure the workforce is effectively and efficiently deployed, and high quality care is maintained.
Whilst it is clear that practices are becoming increasingly multi-disciplinary, with a wider range of staff involved in direct patient care representing more varied roles, identifying the optimal mix of professionals is complex. Historically workforce planning has been uni-disciplinary, but promotion of workforce flexibilities for care delivery relies on a range of disciplines and requires a different approach to workforce planning
What is the design of the study?
This part of the study, Work Package (WP) 5 (one of 7 work packages) is taking place post Covid-19. It will primarily focus on qualitiative methods to understand team working. It will assess how decisions about workforce composition and roles are made and evaluate different workforce structures. Team climate will be explored in terms of impact on the delivery and quality of patient care, job satisfaction and the effective functioning of the practice team. Complementary methods will interrogate these areas from different perspectives: a) a national survey of team members in general practices; b) in depth analysis of team working in a panel comprising up to 24 diverse practices.
Oxford RCGP RSC is working with the CRN to encourage participation by GP Practices to take part in the nationwide survey.
The national survey of staff in general practices will be conducted to explore team climate, staff wellbeing and job satisfaction.
WHY TAKE PART?
Feedback will be provided to practices on anonymised practice-level findings with benchmarking to other local practices and to practices nationwide of a similar size and character (e.g. urban / rural, deprivation level). This will ensure that participation is useful for individual practices, as the feedback will helpfully inform team planning and training. It is hoped that provision of this information, and the brief nature of the survey instrument will encourage practices to take part.
WHO CAN TAKE PART?
Practices that employ more than five staff members (head count) will be eligible to express an interest in taking part. All staff in practices that volunteer will be provided with a brief online questionnaire. Practice managers will be asked to assist with distribution of an information sheet and link to the survey (which will be based on Qualtrics software).
Questionnaires will be completed anonymously and submitted direct to the research team. The survey is brief to encourage participation, taking a maximum of five minutes to complete. It has been piloted and refined n advance of full distribution. IThe questionnaire includes basic demographic
factors (age, gender, role (GP, nurse / other direct patient care, administrative/ management), time in practice). Staff are also sked whether they currently work on the practice premises, from home, or a mixture of both. Job satisfaction will be measured using the overall satisfaction item from the Warr Cook Wall measure, which
has been found appropriate for clinical and non clinical staff in practice settings.
Responses will be entered or downloaded into a secure database, organised by practice identifier. Data from any practice will be analysed provided more than five responses have been received and over 60% of all staff members have responded.
More information will be available for practices that would like to take part.
Please take this opportunity to find out about your Practice workforce dynamic
Click here to express your interest in taking part