Skill-mix Change and Outcomes in Primary Care

The Centre for Primary Health & Social Care at London Metropolitan University organised a seminar titled: Skill-mix change and outcomes in primary care: Longitudinal analysis of general practices in England 2015–2019.

Dr Igor Francetic and Dr Imelda McDermott, from Population Health, Health Services Research & Primary Care, University of Manchester were the speakers.

Employing new clinical roles in primary care has been proposed as a solution to the shortages of GPs and Nurses. However, evidence on the impacts this has on practice outcomes is limited. We examined outcome responses to changes in skill-mix across general practices in England, focusing on 4 staff categories: GPs, Nurses, Health Professionals, and Healthcare Associate Professionals. We studied 10 indicators of quality of primary care for over 6,000 GP practices in England observed for 5 years. We used both fixed-effect and first-differences regressions to model changes in staff composition and outcomes, adjusting for practice and population factors. Additional GPs and Nurses were positively associated with practice activity and outcomes. The introduction of Healthcare Professionals was negatively associated with patient satisfaction, whilst antibiotic prescribing outcomes improved. We found little evidence of complementarity or substitution between staff groups. These findings suggest caution over the implementation of policies encouraging more employment of different professionals in primary care. During the seminar the speakers provided qualitative evidence to interpret these findings.

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