Research to define an accurate measure of labour productivity in primary care and to identify its determinants, including workforce skill mix, technology, and patient characteristics, has been awarded funding by the Health Foundation’s Efficiency Research Programme.
Led by the Office of Health Economics, the three-year project is in collaboration with the Royal College of General Practitioners’ Research and Surveillance Centre (RCGP RSC), which has recently relocated to the University of Oxford’s Nuffield Department of Primary Care Health Sciences.
NHS England’s General Practice Forward View makes a number of commitments to reverse historic underinvestment in primary care, including a £2.4 billion investment by 2020/21 and recruitment of additional medical workforce to reverse current understaffing trends.
This investment aims to tackle the increasing pressure on primary care services, driven in part by a decline in the number of GPs per head of population since 2009. Despite this investment, it is important that there is a continual improvement in general practice efficiency and effectiveness to prevent a growing population with increasingly complex and multimorbid patients from eroding this investment.
A consensus has emerged on the areas where general practice productivity could be increased, as summarised in the Forward View and by the Primary Care Workforce Commission. For example, greater use of workforce enhancing technology, optimising skill mix, and greater use of role substitution. However, at present, there are few concrete recommendations in these areas.
Using a multimethod approach, spanning qualitative and quantitative research methods, this project will fill the current gaps in knowledge by delivering evidence-based recommendations for improving performance among practices and on the determinants of primary care labour productivity.
A systematic literature review will inform the development of new measures of labour productivity in primary care that can account for both the quality of care and multiple output dimensions. Econometric analyses will then shed light on questions around the optimum staffing levels and skill mix, the trade-off between efficiency and effectiveness, the potential impact of technology in shifting the primary care production function, and the scope of using better triage alongside skill mix improvements. This analysis will employ data from the RCGP’s RSC, a high-quality dataset of routinely collected patient and practice level information from approximately 410 GP practices in England.
Findings from this research have the potential to deliver immediate policy impact, given the timing of the NHS Forward View implementation. A reproducible algorithm for measuring primary care labour productivity will also be released to enable ongoing performance measurement and long-term service improvement across the entire primary care sector.
The team contributing to this research includes Simon de Lusignan, Professor of Clinical Informatics and Health Outcomes, University of Oxford with Graham Cookson, Patricia Cubi-Molla, Margherita Neri and Bernarda Zamora from the OHE.