• Br J Gen Pract · Sep 2023

    How new clinical roles in primary care impact on equitable distribution of workforce: a retrospective study.

    • Joseph Hutchinson, Yiu-Shing Lau, Matt Sutton, and Kath Checkland.
    • Centre for Primary Care and Health Services Research, University of Manchester, Manchester.
    • Br J Gen Pract. 2023 Sep 1; 73 (734): e659e666e659-e666.

    BackgroundThere 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, have stimulated employment of new healthcare roles. However, it is not clear whether this will impact inequalities.AimTo examine whether the ARRS impacted inequality in the distribution of the primary care workforce.Design And SettingA retrospective before-and-after study of English PCNs in 2019 and 2022.MethodThe study combined workforce, population, and deprivation data at network level for March 2019 and March 2022. The change was estimated between 2019 and 2022 in the slope index of inequality (SII) across deprivation of full-time equivalent (FTE) GPs (total doctors, qualified GPs, and doctors-in-training), nurses, direct patient care, administrative, ARRS and non- ARRS, and total staff per 10 000 patients.ResultsA total of 1255 networks were included. Nurses and qualified GPs decreased in number while 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% confidence interval [CI] = -0.841 to -0.122, P<0.01) and a pro- poor change for doctors-in-training (0.161, 95% CI = 0.049 to 0.274, P<0.01). Changes in distribution of all other staff types were not statistically significant.ConclusionBetween 2019 and 2022 the distribution of administrative staff became less pro-poor, and doctors-in-training became pro-poor. 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 the primary care workforce.© The Authors.

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