Dr John Ford and Claire Nussbaum discuss their updated analysis of UK primary care workforce inequalities. Dr Ford is Clinical Lecturer in Public Health at the Primary Care Unit.
A fair distribution of primary care staff is a key building block to reducing health and care inequalities.
In 2021 we published a paper showing how primary care workforce inequalities widened between 2015 and 2020 and developed an interactive dashboard showing regional inequalities.
Using the same methods, we have now updated the analysis to included data up to June 2022. The analysis was covered by the BBC on 4 November 2022 and discussed on BBC Newsnight and BBC Radio 6.
The data shows that primary care workforce inequalities remain as wide as ever.
What do the latest data reveal?
Inequalities in the distribution of GPs as wide as ever
Inequalities in the distribution of GPs widened from 2015 to 2019 and have continued at that level since. If we take those practices in the most deprived are (decile 10, red line in the figure below) and those practices in the least deprived area (decile 1, blue line) we can see that while there wasn’t much difference in 2015 the gap has widened over time.
In fact, in the most deprived areas the number of GPs per 10,000 patients reduced from 5.6 to 5.3 from 2015 to 2022, but in more affluent areas the number of GPs per 10,000 patients increased from 5.6 to 5.8.
This means that an average practice of 10,000 patients in an affluent area would have on average have about 2.5 days more GP time per week than those in the most deprived areas.
Decile 1 – least deprived 10%; Decile 10 – most deprived 10%
As the deprivation score of a practice goes up, the number of GPs goes down
Looking at just the extreme ends can be misleading because it ignores all the practices in between.
To look at all the practices we used a measure called slope index of inequality. This is a measure of the steepness of inequality across all practices. A slope index of inequality of 0 means there are no inequalities. In this case a negative slope index of inequality means that as the deprivation score of a practice goes up, the number of GPs goes down.
We find that the steepness of this relationship increased, meaning greater inequality, from 2015 to 2019 and has since stayed at the same level.
When we take into account the patient characteristics (as measured by Carr Hill weighting, see paper for detailed methodology), the inequality is even greater.
A negative SII value indicates fewer GPs employed in more deprived deciles
More deprived areas tend to have more practice nurses
When we look at practice nurses, we see that more deprived areas tend to have more practice nurses.
The number of nurses per 10,000 patients has increased slightly in more deprived areas (from 2.5 to 2.7 from 2015 to 2022) and in more affluent areas the number of nurses has stayed roughly the same (about 2.3). This may be to compensate in part of a lack of GPs, but the difference is much smaller (about 1 day per week per average practice of 10,000 patients).
When we look at the slope index of inequality, we see more practice nurses in more deprived areas. However, when we adjust for patient characteristics there are fewer practice nurses in deprived areas.
A positive SII value indicates more nurses employed in more deprived deciles
How these data were produced
For full methodology, please see the original paper here. In brief, we used nationally published General Practice workforce data (available here) and linked it with practice Index of Multiple Deprivation scores (available here). Importantly these data do not include Primary Care Network staff employed under the Additional Roles Reimbursement Scheme.
Further information about the dashboard
The dashboard maps sustainability and transformation plan (STP)-level inequalities in the general practice workforce across England. It can be filtered by staff role (GPs, nurses, total direct patient care (DPC) staff), quarter (March through June 2022), or STP. The map on the left shows the average number of FTE staff per 10,000 patients in each STP. The bar graph on the upper right shows the socioeconomic gradient of FTE staff by Index of Multiple Deprivation (IMD) quintile. The table on the lower right lists the individual practice-level data. Selecting a single STP, either by clicking directly on the map or by using the STP filter, will display the workforce distribution within that STP area. Workforce data were obtained from the NHS Digital General Practice Workforce collection and Index of Multiple Deprivation (IMD) data were obtained from the Fingertips National General Practice Profiles. Please note that this data is not adjusted for age, sex, or other characteristics related to patient need and therefore only reflect the raw number of FTE staff per 10,000 patients in each practice.
Find out more
Contact Dr John Ford: firstname.lastname@example.org