General Practice Workforce 31 October 2020

This release of the General Practice Workforce Official Statistics has been affected by several significant events which have had – or will have – an effect upon the figures.

We are currently releasing only full time equivalent figures in this publication but will update the publication with headcount figures as soon as possible.

There is evidence to suggest that the completeness and coverage of data extracted from the NWRS for March and June was adversely affected by a range of issues including the COVID-19 pandemic and that the exceptional pressures on the general practice workforce meant not all practices were able to update their NWRS data in time for the extracts on 31 March and 30 June.

For September, we were confident the practices had returned to normal levels of data completion in time for the extract on 30 September.

However, October 2020 was the first time that GP workforce data had been collected on a monthly basis. Prior to this, the data collection was quarterly and taken at the end of March, June, September, and December.

The National Workforce Reporting System (NWRS) collection tool holds records of all practice staff, and registered users of the tool – generally members of the practice staff –update these records as necessary, for example adding details of staff joining the practice, amending working hours and other information, or closing records where staff have left. This includes information about long-term and regular locum GPs working at their practices.

While we ask practices to maintain the records in the NWRS on a regular and ongoing basis, the evidence suggests that many practices update their data towards the end of the reporting period, shortly before the data extracts take place. However, the transition to a monthly data collection and reporting cycle means that practices will need to ensure that any new records or updates are recorded in the NWRS in a timelier manner.

Some practices employ locum GPs on a long-term or regular basis, for example to provide cover for maternity leave or for a recurring weekly or monthly session. In these cases, the locum’s details are recorded in the main part of the NWRS together with records for permanent practice staff. This means long-term locums’ records require minimal maintenance from one month to another. However, some locum provision is needed on a more ad-hoc basis, for example to cover one or more sessions at short notice. In such circumstances, practices enter summary details of the locum GP and the number of hours worked during the entire reporting period. Until October 2020, this meant practices provided information about these “infrequent” locums and their working hours over the preceding three months.  However, now that we are collecting general practice workforce data on a monthly basis, we need GP practices to provide information about infrequent locums each month.

There was a significant decrease in the number of full time equivalent (FTE) infrequent locums reported in the October 2020 data extract. In addition, we are aware that a far lower percentage of GP practices logged onto the NWRS during the month than we had expected. This may be because practices are not yet accustomed to the monthly process and had overlooked the need to ensure that all data additions and changes – particularly for their infrequent locum staff – had been made by 31 October. It is also possible that increasing workload pressures due to the COVID-19 pandemic meant that some NWRS users did not have time to enter details of infrequent locums working at their practices during October.

We are aware that locum usage was significantly reduced earlier this year as a result of COVID-19. This reduction in locum usage coincided with a decrease in the number of appointments offered by general practices, whether face-to-face or by telephone or video call. However, we can see that the number of general practice appointments delivered during October is more in keeping with expected levels (https://digital.nhs.uk/data-and-information/publications/statistical/appointments-in-general-practice) and have no reason to believe that the large decrease in infrequent locum FTE is indicative of reduced locum usage during October rather than being a data quality issue.

We considered a range of options to address this issue with the data completeness for these infrequent locums, which included the possibility of asking practices to submit retrospective data as part of the collection at the end of November. However, we are mindful of the burdens that practices face in the normal course of events and that COVID-19 is adding to those pressures. As a result, we have calculated CCG-level FTE estimates for these missing locum records based upon usual patterns of usage as far as we have been able to determine. However, we have not yet been able to devise a methodology for estimating headcount figures for the missing infrequent locum data as this is complicated by the fact that infrequent locum FTE totals can be composed of a large number of individual locum GPs working a relatively low number of sessions. Furthermore, as we have never before collected GP workforce data for October we have only quarterly trends to inform our estimates.

Where practices were able to provide information on infrequent locums working for them in October, this has been included in the counts. We have estimated CCG-level figures for the missing FTE figures and allocated them on a pro-rata basis according to historical patterns of usage.

We are working on a methodology to estimate headcount figures for infrequent locums and aim to release headcount figures as soon as possible. We are also working closely with colleagues in NHS England to support GP practices at this challenging time and will review the completeness and coverage of the infrequent locum data when November’s data extract is received.

Since July 2019, all GP practices in England have had the opportunity to join one of around 1,250 Primary Care Network and the vast majority have taken the opportunity to do so. PCN member organisations, which include GP practices, and other health, social care, mental health, and voluntary sector providers, will deliver accessible and integrated care to local communities.

These PCNs have their own distinct direct patient care workforces and data relating to these staff was collected for the first time on 31 March 2020. There is a helpful overview of PCNs and a new series of experimental statistics at https://digital.nhs.uk/data-and-information/publications/statistical/primary-care-network-workforce.

It is possible that some individuals previously working in a GP practice may transfer some or all of their working hours to their new PCNs. In particular:

• All PCNs are required to have a suitably qualified accountable person to act as the clinical director. This post is usually filled by a GP, nurse or another direct care professional and typically requires a commitment of 0.25 FTE. It is therefore possible that FTE counts of staff in these job roles will decrease in the general practice workforce statistics as some of their working hours are transferred to the PCNs.
  PCNs employ GPs or nurses only in the capacity of clinical directors - they do not employ GPs or nurses to deliver patient care

• Some clinical pharmacists and pharmacy technicians formerly working in general practice will transfer some or all of their working hours to their local PCN which will reduce the FTE and headcount figures in the General Practice Workforce statistics for staff in these roles.
• There may also be decreases in the FTE counts for some other roles such as administrative staff and other direct patient care professionals if they begin to work full or part-time for the PCN.

We are working closely with data providers to ensure that the reported hours of staff working on both general practices and PCNs are recorded correctly to prevent double counting.

We have included information about each GP practice’s PCN in the practice level CSV file. When considering these general practice statistics by PCN, please take note of the following points:

• Aggregating from GP practice to PCN to CCG will not replicate the CCG figures
  This is because we estimate for missing records at CCG level but not at a lower level meaning the CCG totals would be higher than the sum of the PCN figures.

• Because membership of a PCN is not mandatory, some practices have chosen not to join a PCN and information about their workforces will not be included in any PCN totals.

• While PCN boundaries are generally expected to align with CCG boundaries there are some exceptions, notably where effective and successful cross-CCG collaborative working was already in place. In this instance, a responsible CCG is identified for PCN-data reporting purposes even if some GP practice members belong to a different CCG.

• The PCN structure is not static and some PCNs have already closed, merged or been recently opened. Similarly, some GP practices have changed their PCN membership – a few have done so several times – since the PCNs were first formed in July 2019, and some GP practices that were originally PCN members have left the local PCN but not joined another.

• We have no plans to retrospectively re-map PCN membership in the practice-level CSVs as practice membership changes.

Information about PCNs, the GP practice members and the relationships to CCGs are available from the Organisation Data Service (ODS) (https://digital.nhs.uk/services/organisation-data-service/primary-care-networks---publication-of-organisational-data-service-ods-codes) which receives monthly updates about PCNs and their member organisations.

This publication includes a standalone table of counts of PCN Clinical Directors. We began collecting information on PCN Clinical Directors during 2019 when the PCNs were first set up, and before the PCN module of NWRS was available.

The role of Clinical Director is only available for use in PCNs and we have asked practices to transfer details of all staff holding PCN roles - including Clinical Directors - to the PCN module in the NWRS collection. Therefore, these Clinical Directors do not constitute part of the General Practice workforce which is why they are being reported separately.

We anticipate that all practices will transfer Clinical Directors to the applicable PCNs over the next few months and that this standalone table will be withdrawn.