The Government’s ‘rapid expansion’ of additional staff in GP practices has not improved patient satisfaction, a new analysis has found.
A report by the Institute for Government (IfG) published this week has argued that patient satisfaction is higher in practices with more GP partners, smaller list sizes and more face-to-face appointments.
But the report warned that these trends are all ‘heading in the opposite direction’, as the number of GP partners continues to fall while practices do ‘far more’ appointments remotely than before the pandemic.
The IfG found that patient satisfaction tends to increase with more GP appointments, but ‘not significantly so with non-GP appointments’.
The think tank used regression analysis to examine the relationships between different practice characteristics and patient satisfaction, which it said had seen a ‘steep decline’ in recent years.
Patients rating their experience of general practice as ‘very’ or ‘fairly’ good fell from 88.4% in 2012 to 71.3% in 2023, with much of that fall taking place in the last few years since the pandemic.
The report advised the Government to ‘urgently address’ the attractiveness of becoming a partner and to ‘make better use of the massively expanded patient care workforce’.
It pointed to the addition of almost 40,000 direct patient care staff – such as physiotherapists, pharmacists and care coordinators – since 2019, but this has had ‘no significant effect on satisfaction or QOF scores’.
It said: ‘When looking at the practice level, there is a clear trend of increasing satisfaction as the number of GPs per 100,000 weighted patients increases.
‘GP partners are associated with the largest effect on patient satisfaction: one additional GP partner per practice is associated with a 1.4ppt increase in satisfaction.
‘In comparison, the same number for salaried GPs and GP trainees is 0.9 and 0.3 respectively. An additional nurse is associated with an increase of 0.2ppt of patients satisfied with their practice.
‘An additional direct patient care staff member has no statistically significant effect on patient satisfaction.’
On GP trainees, the report warned that despite doubling the number of GP training places between 2016 and 2024, these trainees ‘are not translating into the fully qualified workforce at the same rate’.
Recent NHS data analysis suggested that just over 40% of GP registrars who qualified in 2022 and 2023 have not yet taken up substantive roles in UK general practice.
The report added: ‘The Government has tried to expand the GP workforce. It has more than doubled the number of GP trainees between 2016 and 2024 – but those trainees are not translating into the fully qualified workforce at the same rate.’
It pointed out that there is no data about vacancy rates in general practice, or the number of GPs that are ‘seeking work’, but that there is ‘anecdotal evidence’ of an ‘employment paradox’ in the service.
‘This is where a need for additional GPs and a desire to increase the number of fully qualified staff exists alongside a large number of GPs who are out of work and seeking a role,’ the report added.
The report also mentioned a white paper on workforce by Pulse’s publishers Cogora which showed that two reasons for this paradox may be a lack of funding to employ staff and a lack of physical space in which they can work.
Full recommendations to Government
- Urgently address some of the factors that make being a GP partner less attractive, including:
- the high cost of entering partnership;
- the unlimited financial liability that comes with most partnerships (particularly related to the ownership of premises);
- fears of being the ‘last partner standing’;
- and increasing workloads.
- Assess whether other models could be more appropriate and plan accordingly, if it thinks that the partnership model is no longer a feasible way of delivering general practice.
- Better understand why more GP trainees don’t join the fully qualified workforce and take action to address these problems through an updated NHS Long Term Workforce Plan.
- Make better use of the massively expanded direct patient care workforce. As a start, it should improve the quality of data collected about their activity.
- Be clear about the role that it wants general practice to play in a reformed NHS. There is likely a trade-off between increasing access to general practice through expanded use of remote appointments and a decline in some indicators of service performance such as patient satisfaction and continuity of care.
- If the government does choose to prioritise access, it must communicate its reasons for doing so and attempt to mitigate some of the negative consequences.
Source: Institute for Government
Pulse’s major series on general practice workforce, published earlier this year, looked at how the GP recruitment crisis remains despite GPs being out of work and overall staffing numbers exploding.
In January, the Nuffield Trust urged NHS England to ‘urgently’ review the impact of the Additional Roles Reimbursement Scheme which could be ‘distorting’ staffing decisions.
