In August 2021 NHS Digital revised the entire General Practice workforce time series back to September 2015 making several methodological changes to the way in which the workforce numbers are calculated. The main element of these changes was the removal of fully estimated records (where a practice has not provided any (valid) data for a staff group). These estimates were calculated according to perceived levels of local need for each job role and were based upon national staffing patterns which relied on all practices and CCGs having an equal need for staff in every job role. The creation of Primary Care Networks (PCNs) in 2019 introduced significant changes to the national primary care workforce. PCNs work collaboratively with general practices and other health and social care providers and share staff – primarily in the DPC group – across the network. This means that it is increasingly likely that PCNs will employ DPC staff and that fully estimated records will inflate figures for this particular staff group.
Following stakeholder feedback and combining with the need to address how monthly data will be published, NHS Digital have reviewed the removal of fully estimated records.
The review aimed to answer two main questions:
- Was the removal of these estimates and redefinition of the historical timeseries the most appropriate solution for ensuring an accurate and consistent timeseries?
- How appropriate would it be to estimate for missing staff, given near complete data and a changed primary care landscape with the formation of Primary Care Networks, who may now be employing these staff - particularly those in the Direct Patient Care staff group?
Testing the estimation methodology on historical data
This was done in two ways.
- The England average job role to registered patient ratio was calculated based on all supplied data. This ratio was then used to calculate an estimated headcount and FTE for each job role at each practice, and the results compared to the submitted data. This analysis was repeated on only half the records to further test the methodology. Calculating CCG-level job role to registered patient ratios were then investigated to see whether they would produce better results than an England-level figure.
- Practices in March 2016 who supplied no data for one of the staff groups and therefore had estimated records, were tracked to a more recent period to see whether staff do appear in these groups in later period. A comparison was then made between the estimated data and the ‘real’ data.
The appropriateness of estimating for missing staff
Our Data Liaison Service contacted practices who do not currently submit data for some or all staff groups. This includes practices who have no records at all within NWRS for a staff group, and others who do have staff records but they either all fail validation, or all relate to staff members who have been recorded as leavers.
Questions put to these practices were designed to ascertain whether they genuinely do not have staff members in each of the staff groups they did not submit data for.
Testing the estimation methodology indicated that estimating for staff groups apart from DPC was appropriate despite likely over-estimation and using the STP based ratios improved the reliability. For the DPC staff group the methodology was deemed not to be reliable.
Results from the feedback and discussions with practices indicated that there are a significant number of practices that do not have DPC staff and therefore we should not estimate. Equally, about the same number reported they needed to update their data for this staff group. For other staff groups, it is more difficult to draw firm conclusions due to the smaller numbers engaging however for the majority of those practices who did engage, their records needed to be updated.
Alternatives to estimating for missing staff groups were also investigated including estimating for missing practice rather than staff groups. Another alternative considered was adding information on the percentage of practices included in the analysis for each staff group in published tables to add context. This reduces the impact of increases in data quality and participation on the scale of change and demonstrates where data are missing.
Conclusion and next steps
Estimates will be introduced for GPs, nurses and administrative staff as this is better than not estimating even though over-estimation remains. We will use estimates based on STP rather than national ratios.
For the DPC staff group, using the same estimation methodology is not appropriate. An alternative approach which limits the degree of over-estimation by not estimating for practices who have provided information about GPs, nurses and admin/non-clinical staff and are only missing DPC staff will be used. This approach is based on an assumption that the majority of practices who provide information about three staff groups but not DPC are likely to not employ DPC staff.
We intend to re-introduce the general practice workforce timeseries when 31 December 2021 data are published in early February 2022.
When the series is re-introduced the entire series back to September 2015 will be released. As general practice workforce data is now available monthly, the length of the timeseries released each month subsequently will be shorter.
We will continue to work closely with practices to help them complete and keep their data up to date.
More information about this review and full details about the resulting plans can be found in the Methodological Change Notice.