Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
Research Department of Primary Care and Population Health, University College London, London, UK.
BMJ Open. 2024 Sep 3;14(8):e081535. doi: 10.1136/bmjopen-2023-081535.
To describe trends in the organisational structure, workforce and recorded appointments by role in English general practice.
Retrospective longitudinal study.
English general practice.
NHS England, Office for Health Improvement and Disparities and Care Quality Commission national administrative datasets covering between 5 to 10 years from 2013 to 2023.
Between 2013 and 2023, the number of general practices fell by 20% from 8044 to 6419; the average practice list size increase by 40% from 6967 to 9724 patients. The total population covered by providers with over 100 000 registered patients reached 2.3 million in 2023 compared to 0.5 million in 2017. The proportion of practices under individual ownership decreased from 13% to 11% between 2018 and 2023; there was little change in the proportion owned by partnerships, incorporated companies or NHS bodies, which respectively averaged around 80.3%, 6.9% and 0.7%. Between 2015 and 2022, there was a 20% rise in the total full-time equivalent (FTE) general practice workforce, including Primary Care Network staff, from 1.97 to 2.37 per 1000 patients because of an increase in multidisciplinary other 'Direct Patient Care' (DPC) and administrative roles. The number of nurses remained stable, and the number of qualified general practitioners (GPs) decreased by 15%. In September 2022, there were 0.45 FTE qualified GPs per 1000 patients; GPs and other DPC roles, excluding nurses, each represented 19% of the FTE per 1000 patients workforce; administrative roles represented 51%. The general practice workforce is predominantly female. A quarter of GPs qualified overseas. Between 2018 and 2023, there was no clear upward or downward trend in total appointments per 1000 patients with, on average, half provided by GPs.
Since 2013, there has been a shift in general practice towards larger practices with more multidisciplinary teams, alongside a reduction in the number of FTE qualified GPs per 1000 patients. We recommend that the impacts of these changes on access, quality and costs are closely monitored.
描述英国普通科医生组织结构、劳动力和按角色记录的预约趋势。
回顾性纵向研究。
英国普通科医生。
英国国家医疗服务体系（NHS）英格兰、卫生改善和差异办公室以及护理质量委员会的国家行政数据集，涵盖 2013 年至 2023 年的 5 至 10 年。
2013 年至 2023 年间，普通诊所的数量从 8044 家减少了 20%至 6419 家；平均就诊人数增加了 40%，从 6967 人增加到 9724 人。在 2023 年，有超过 10 万名注册患者的提供者所覆盖的总人口达到 230 万人，而 2017 年为 50 万人。个体所有的诊所比例从 2018 年的 13%下降到 2023 年的 11%；合伙制、股份制公司或 NHS 机构所有的比例几乎没有变化，分别平均为 80.3%、6.9%和 0.7%。2015 年至 2022 年间，由于多学科其他“直接患者护理”（DPC）和行政角色的增加，每 1000 名患者的全职等效（FTE）普通科医生劳动力（包括初级保健网络工作人员）增加了 20%，从 1.97 人增加到 2.37 人。护士人数保持稳定，合格的全科医生（GP）人数减少了 15%。2022 年 9 月，每 1000 名患者有 0.45 名 FTE 合格的 GP；GP 和其他 DPC 角色（不包括护士），每个角色占每 1000 名患者 FTE 劳动力的 19%；行政角色占 51%。普通科医生劳动力主要为女性。四分之一的 GP 在海外获得资格。自 2018 年以来，每 1000 名患者的总预约数量没有明显的上升或下降趋势，平均有一半由 GP 提供。
自 2013 年以来，普通科医生的工作模式向拥有更多多学科团队的大型诊所转变，同时每 1000 名患者的合格 GP 的 FTE 数量减少。我们建议密切监测这些变化对可及性、质量和成本的影响。
