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

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, have stimulated employment of new healthcare roles. However, it is not clear whether th...

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Autores principales: Hutchinson, Joseph, Lau, Yiu-Shing, Sutton, Matt, Checkland, Kath
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Royal College of General Practitioners 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10471141/
https://www.ncbi.nlm.nih.gov/pubmed/37604700
http://dx.doi.org/10.3399/BJGP.2023.0007
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author Hutchinson, Joseph
Lau, Yiu-Shing
Sutton, Matt
Checkland, Kath
author_facet Hutchinson, Joseph
Lau, Yiu-Shing
Sutton, Matt
Checkland, Kath
author_sort Hutchinson, Joseph
collection PubMed
description 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, have 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 the primary care workforce. DESIGN AND SETTING: A retrospective before-and-after study of English PCNs in 2019 and 2022. METHOD: The 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. RESULTS: A 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. CONCLUSION: Between 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.
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spelling pubmed-104711412023-09-01 How new clinical roles in primary care impact on equitable distribution of workforce: a retrospective study Hutchinson, Joseph Lau, Yiu-Shing Sutton, Matt Checkland, Kath Br J Gen Pract Research 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, have 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 the primary care workforce. DESIGN AND SETTING: A retrospective before-and-after study of English PCNs in 2019 and 2022. METHOD: The 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. RESULTS: A 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. CONCLUSION: Between 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. Royal College of General Practitioners 2023-08-22 /pmc/articles/PMC10471141/ /pubmed/37604700 http://dx.doi.org/10.3399/BJGP.2023.0007 Text en © The Authors https://creativecommons.org/licenses/by/4.0/This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/licences/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ).
spellingShingle Research
Hutchinson, Joseph
Lau, Yiu-Shing
Sutton, Matt
Checkland, Kath
How new clinical roles in primary care impact on equitable distribution of workforce: a retrospective study
title How new clinical roles in primary care impact on equitable distribution of workforce: a retrospective study
title_full How new clinical roles in primary care impact on equitable distribution of workforce: a retrospective study
title_fullStr How new clinical roles in primary care impact on equitable distribution of workforce: a retrospective study
title_full_unstemmed How new clinical roles in primary care impact on equitable distribution of workforce: a retrospective study
title_short How new clinical roles in primary care impact on equitable distribution of workforce: a retrospective study
title_sort how new clinical roles in primary care impact on equitable distribution of workforce: a retrospective study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10471141/
https://www.ncbi.nlm.nih.gov/pubmed/37604700
http://dx.doi.org/10.3399/BJGP.2023.0007
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