Workload in primary care and quality of care
Understanding the productivity of general practitioners (GPs) is an important topic for health economics and policy development, as GPs play a central role in the health care system. In many economic activities, capacity is fixed or modifiable only at a high cost, while demand tends to be uncertain. In industries such as airlines, hotels and car rentals, adjusting prices to reflect the cost of serving the marginal consumer is easy. However, in professional services industries such as banking, legal services and health care, prices are kept largely stable and are changed infrequently.
In this project, the successful candidate will examine the capacity constraints that arise in the case of primary care and how "skill mix" may be affecting the quantity and complexity of GP workload. This is a particularly interesting case because primary care provision is associated with improved population health and lower aggregate health care costs.
A common measure of workload in the primary care setting is the number of patients a GP, or increasingly other members of the primary care team, sees over a given period. Based on this notion, the measure of workload that will be used in this study is the total number of daily contacts during work time for each GP or other member of the primary health care team.
In particular, the aims of this project are to assess:
- How professional services, and health care services in particular, deal with uncertain demand when the number of GPs is falling and other staff (nurses, paramedics, pharmacists, physician associates and others) are acting as GP substitutes;
- How workload in primary care has evolved over recent decades;
- What is the annual cost associated with the workload in primary care?
- What consequences are there from workload variation levels and variation in the quality of services for the health status of patients?
There is scope to explore this topic using the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network and database of practices (and their patients), which has been recruited to be nationally representative. The RCGP RSC network is one of the UK's freshest data sources uploading data twice per week. The RCGP RSC data and analytics hub is based in the Nuffield Department of Primary Care Health Sciences and there is scope for working with practices, including providing online feedback via a dashboard, as well as working on our database.
Using these clinical and administrative data and an empirical research framework, the candidate will examine the effects of workload on the delivery of care, and other proxy measures for quality of care. The outcomes of interest will include: a) Referrals to the emergency room, b) Referrals to a specialist with no follow up, c) Drug prescriptions, d) Mortality, e) Hospital admissions and readmissions, and e) Number of follow up visits to the GP.
Finally, the successful candidate will estimate the economic consequences of the different patterns of GP workload. The candidate will be supervised by health economists and clinical informatics academic GPs within the Nuffield Department of Primary Care Health Sciences.