Nussbaum Claire, Massou Efthalia, Fisher Rebecca, Morciano Marcello, Harmer Rachel, Ford John
MPhil Candidate, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
Research Associate, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
BJGP Open. 2021 Oct 26;5(5). doi: 10.3399/BJGPO.2021.0066. Print 2021 Oct.
In England, demand for primary care services is increasing and GP shortages are widespread. Recently introduced primary care networks (PCNs) aim to expand the use of additional practice-based roles such as physician associates (PAs), pharmacists, paramedics, and others through financial incentives for recruitment of these roles. Inequalities in general practice, including additional roles, have not been examined in recent years, which is a meaningful gap in the literature. Previous research has found that workforce inequalities are associated with health outcome inequalities.
To examine recent trends in general practice workforce inequalities.
DESIGN & SETTING: A longitudinal study using quarterly General Practice Workforce datasets from 2015-2020 in England.
The slope indices of inequality (SIIs) for GPs, nurses, total direct patient care (DPC) staff, PAs, pharmacists, and paramedics per 10 000 patients were calculated quarterly, and plotted over time, with and without adjustment for patient need.
Fewer GPs, total DPC staff, and paramedics per 10 000 patients were employed in more deprived areas. Conversely, more PAs and pharmacists per 10 000 patients were employed in more deprived areas. With the exception of total DPC staff, these observed inequalities widened over time. The unadjusted analysis showed more nurses per 10 000 patients employed in more deprived areas. These values were not significant after adjustment but approached a more equal or pro-poor distribution over time.
Significant workforce inequalities exist and are even increasing for several key general practice roles, with workforce shortages disproportionately affecting more deprived areas. Policy solutions are urgently needed to ensure an equitably distributed workforce and reduce health inequities.
在英国，初级医疗服务的需求不断增加，全科医生短缺现象普遍存在。最近引入的初级医疗网络（PCNs）旨在通过经济激励措施招聘医师助理（PAs）、药剂师、护理人员等基于执业的额外角色，以扩大其使用。近年来，包括额外角色在内的全科医疗中的不平等现象尚未得到研究，这是文献中的一个重大空白。先前的研究发现，劳动力不平等与健康结果不平等相关。
研究全科医疗劳动力不平等的近期趋势。
一项纵向研究，使用2015 - 2020年英格兰季度全科医疗劳动力数据集。
每季度计算每万名患者中全科医生、护士、直接患者护理（DPC）总工作人员、医师助理、药剂师和护理人员的不平等斜率指数（SIIs），并在调整和未调整患者需求的情况下随时间绘制。
在贫困程度较高的地区，每万名患者中受雇的全科医生、DPC总工作人员和护理人员较少。相反，在贫困程度较高的地区，每万名患者中受雇的医师助理和药剂师较多。除DPC总工作人员外，这些观察到的不平等随着时间的推移而扩大。未调整分析显示，贫困程度较高的地区每万名患者中受雇的护士更多。调整后这些数值不显著，但随着时间的推移接近更平等或有利于穷人的分布。
存在显著的劳动力不平等，并且几个关键的全科医疗角色的不平等甚至在加剧，劳动力短缺对贫困程度较高的地区影响尤为严重。迫切需要政策解决方案来确保劳动力公平分配并减少健康不平等。
