Clinical roles carried out by anyone other than a GP or nurse in general practice sees a drop in patient satisfaction, a study from the University of Manchester finds.
It also revealed that the introduction of new roles such as social prescribers, pharmacists, paramedics, and physician associates has not freed GP time.
The findings have ‘profound implications’ for policy makers, say the researchers who urge caution over increasing non-medical clinical roles in GP practices.
The analysis of 6,296 practices in England between 2015 and 2019 is the most detailed to date exploring the impact on delivery and patients’ experience of healthcare of the introduction of new roles.
Published in Social Science & Medicine, the study explored the statistical relationship between the workforce composition and 10 indicators of accessibility, clinical effectiveness, user experiences and health system costs.
It found the employment of more staff in traditional primary care roles, such as GPs and nurses, was positively associated with changes in practice activity and outcomes.
But there were larger drops in patient satisfaction at practices that had employed other healthcare professionals.
On average, for one extra full-time healthcare professional – who was not a nurse or GP – employed at a practice there was a 2.4% drop in overall patient satisfaction, it found. There was also a 1.3% drop in patient satisfaction with making an appointment.
Recent figures show that GP networks in England have hired 1,000 new members of staff under the ARRS scheme in the past three months.
And NHS England recently announced the ‘rapid recruitment’ of up to 2,000 additional social prescribing link workers, health coaches and care coordinators among measures to alleviate GP pressures this winter.
But the researchers found that there was ‘limited evidence’ that the additional staff were freeing up GP or nurse time to do other work or making practices more efficient.
The researchers did find that pharmacists contributed positively towards some tasks, improving the quality of medicine prescriptions and reducing the burden of these activities for existing staff.
Lead author Dr Igor Francetic said it was a complex picture and not about whether these roles should be there at all but about how they should be integrated and what tasks they should do or patients they should see.
He said: ‘There was limited evidence of interaction – in terms of either substitution or complementarity – between the GPs and other roles, suggesting they contribute independently to outcomes and quality in primary care. This goes against the common wisdom that some of these new roles will reduce the workload of existing GPs.’
He said that the introduction of several of these new roles requires substantial supervision from GPs and complex changes to how work is organised, which may ultimately reduce efficiency.
‘These findings have profound implications for the implementation of policies emphasising the benefits of introducing staff with non-traditional roles in primary care,’ said Dr Francetic.
‘That is why we urge caution over the implementation of policies encouraging more employment of different professionals in primary care.’
Hear how recruitment and retention issues for ARRS roles within PCNs can be addressed at our Management in Practice event on 28 September in Newcastle. Register for free here.
