An Investigation of the Scale, Scope and Impact of Skill Mix Change in Primary Care

More and more healthcare in the UK is being transferred from hospital to GP practices. However, GP practices have found it difficult to cope with this increasing workload and this has serious implications for the whole of the NHS. When practices cannot recruit new GPs to take the place of those who leave or retire, one solution is to employ other types of healthcare professionals who are not doctors to deliver care; this is generally referred to as a change in 'skill mix'. Research shows that bringing in other types of practitioner can ease the pressure on GP appointments by increasing the number of appointments practices can offer. These practitioners may be nurses who can prescribe medicines, or a new type of care provider called 'physician associates', or others who may be able to provide some of the care that people need. Also, they may be easier to recruit than GPs and cost less to employ. However, there is limited information about what introduction of non-doctor practitioners means in practice and how this changes what happens for patients, or how it affects the quality of care that is delivered and whether it is more or less costly for the NHS. We know that the training backgrounds of other professionals are different from GP training, which means we should not assume that they can all easily fit in and work in the same way.

In this project the evolving scale, scope and impact of changes in skill mix at national and practice level, and from practice, practitioner and patient perspectives will be studied under 3 research questions and investigated using linked work packages:

1. What is the scale and distribution of skill mix changes in primary care and how is skill mix change associated with outcomes and costs?

2. What motivations drive skill mix deployment at practice level and what is delivered by deployment of different practitioner types?

3. How do skill mix changes affect the experiences of employers, practitioners and patients?

National data will tell us how widely change in skill mix is happening in GP practices and we can look at how that change may affect what happens; e.g. how many patients are referred to hospital specialists or given prescriptions. To get more information about how practices work, we will survey Practice Managers why they choose to employ different types of practitioner and what they expect them to do. We will also spend time in 6 practices, talking to staff about how different types of practitioner work together, and we will ask patients whether they like these new roles and if they know how to get the most benefit from them. Learning how different types of practitioner can contribute to general practice will help to guide practices to recruit and employ the right mix of practitioners. It will also shed light on wider issues of coordination of work in complex settings where professionals are often hard to recruit, explore the nature of boundary work between professionals in care settings and advance understandings of skill mix in healthcare. Excellent access to relevant networks and the participation of a broad range of relevant professional groups and commissioning organisations through an active External Advisory Group, will facilitate the wide dissemination of findings to inform policy makers, commissioners and practices and to support the optimisation of patient experience and care.

The £650,000 grant was awarded in February 2018 by the NHS National Institute for Health Research to Dr Sharon Spooner (University of Manchester), Prof. Damian Hodgson (University of Sheffield), Prof. Anne McBride (University of Manchester), Prof. Katherine Checkland (University of Manchester), Prof. Matt Sutton (University of Manchester), Dr Mark Hann (University of Manchester).