Primary Care Network Workforce, 31 July 2023

Last reviewed September 2022

The PCN data collection module within the National Workforce Reporting Service (NWRS) was launched at the end of February 2020. The NWRS and its predecessor tool have been collecting record-level data on the general practice workforce since 2015 and the collection mechanism is well embedded. The NWRS has inbuilt validations to reduce data input errors, such as limiting the job roles to those on a nationally agreed list, and ensuring only numbers are entered for numeric fields.

Functionality within NWRS enables GP practices whose staff were moving some or all of their working hours to the PCN to transfer details of the applicable staff which allowed the NWRS user in the PCN to import the records, reducing the burden on staff and reducing the risk of error on data entry.

Despite this, figures should be treated with caution and we recommend users consider that people may be employed in a variety of ways depending on each PCN's governance arrangements.

• In some cases, staff are named individuals working specifically for the PCN. These may be individuals directly recruited to the PCN, or staff transferring some or all of their working hours from a GP practice or another organisation.
• Individuals may be directly employed by a member organisation of the PCN – such as a hospital trust or charity – and deployed to the PCN and their details, including working hours for the PCN, are recorded in the NWRS. In these cases, the individual’s employer is reimbursed for the staff costs.
  When the individual’s employer is another NHS organisation, for example a ICB or hospital trust, there is a risk that the working hours of these individuals are counted twice, once for their main employing NHS organisation and again in the PCN numbers. As the data quality improves, it is hoped that more work can be done to address the issue of some workers’ hours being reported in both data sets, but in the interim, users should treat the figures with care and understand that there may be inflation in the counts of NHS staff in these roles.
• In some instances, for Direct Patient Care staff only, a role – for example a physiotherapist – may not be permanently staffed by a single individual. Instead, the working hours are covered by a group of physiotherapists, employed by another organisation such as the local ICB, and deployed to the PCN. From December 2020 onwards, we refer to this provision as contracted services; prior to that point, we used the term pooled resource. 
  In these cases, the providing organisation holds a contract with the PCN to deliver the physiotherapy service and supplies appropriately qualified staff, possibly on a rota’d basis. This means that there is no certainty about who will provide the contracted service for the PCN from one day or week to the next, as this decision about which staff members to send is taken at the discretion of the providing organisation.  Therefore, where the provision is staffed on this contracted services basis, PCNs are able to provide very limited information about the workforce and they submit to NWRS only details of the role and the average weekly working hours provided by the contracted service. This enables us to calculate proxy FTE figures provided by the contracted service, but the absence of personal details such as age, gender, ethnicity and start date means that no information about headcount or workforce characteristics can be inferred for this subset of the PCN workforce.

• The risk of inflated counts is a particular issue for contracted services, where no data is collected about individuals and it is not possible to identify individuals or remove double-counted hours from the totals.  We have added Table 3 to the Excel file which presents the FTE counts for contracted services and the % of the total FTE derived from contracted services staff to try to quantify the potential scale of any double-counting of these staff who may, for example, be included in staff totals in the NHS Hospital and Community Health Service (HCHS) Official Statistics (https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics).  As we are unable to determine how many individuals work in these services, we cannot calculate headcount figures for staff providing these contracted services.
• Because the data collected on contracted services does not include any information on start dates, nothing can be inferred about the capacity of the service during the reporting period. For example, the NWRS extract may record that the physiotherapist contracted service provided an average of 75 hours per week, which equates to two FTE staff. However, we cannot determine from the data extract whether this level of provision has been in place for the entire reporting period, or whether it is only recently available. In subsequent data extracts, we will be able to identify changes in the level of provision but even so, we will be able to state solely that the changed provision was available at the end of the period; no other assumptions about the scale of provision over the period can be made.

• In July 2021, we introduced a new version of the National Workforce Reporting Service (NWRS). The new workforce reporting service is easier to use and has been designed with direct feedback from users. In the contracted services section of the new NWRS, users now need to set the average weekly hours to zero where that service has not been used in the latest period. Previously, users marked the relevant record as inactive.  

  The contracted services data in the September 2021 collection showed a larger than usual increase in FTE. It is possible that this was in part due to PCNs leaving hours information untouched within records for services they have not used, rather than setting them to zero. Guidance has since been issued directly to PCNs to explain this process and this should have resulted in more accurate contracted services information being submitted for subsequent collections.

NHS Digital seeks to minimise inaccuracies and the effect of missing and invalid data but responsibility for data accuracy lies with the organisations providing the data. Methods are continually being updated to improve data quality. Where changes impact on figures already published, this is assessed but unless it is significant at national level figures are not changed.

PCNs are contractually required to provide this data on their workforce, and detailed guidance was produced to help them to do so which will be reviewed and updated as needed.

Details about the completeness and coverage for this specific release is available in the Data Quality - July 2023 section.

Since their initial creation, some PCNs have merged into a single organisation while others have divided to form several new PCNs. As a result, the PCN population is still evolving. Similarly, a small number of GP practices have changed their PCN membership at some point since July 2019, while a couple of practices left their PCN without joining another.

The Organisation Data Service (ODS) provides information on PCNs which includes the relationships between practices, PCNs and ICBs. Although some PCNs cross ICB boundaries, the ODS data identifies a single ICB as the PCN “parent” even though some GP practice members may be accountable to a different ICB for non-PCN-related purposes. This should reduce the potential for confusion arising from the complicated PCN structures and geographical responsibilities. Nonetheless, the fact that a few GP practices are members of PCNs that align to a different ICB to the practice’s own ICB should be taken into consideration when reviewing the PCN workforce at ICB-level.

FTE

Full-Time Equivalent (FTE) is a standardised measure of the workload of an employed person and allows for the total workforce workload to be expressed in an equivalent number of full-time staff. 1.0 FTE equates to full-time work of 37.5 hours per week, an FTE of 0.5 would equate to 18.75 hours per week.

PCNs are asked to submit the number of contracted weekly hours for an individual, but also have the option to submit average weekly hours worked across the period (which since January 2023, is a month), separately. This option is of particular importance where contracted hours would not be relevant for an individual (for example, where the staff member is on a zero hours contract).

We calculate the full-time equivalence (FTE) for each record based on these fields. For the majority of staff we use contracted hours in the first instance, only using working hours if contracted hours is missing or zero.  The exception to this rule is those individuals on a zero hours contract. For these staff, we calculate FTE based on their working hours in the first instance, but use contracted hours if working hours is missing or zero. Regardless of contract type, if both fields are missing or zero, these individuals are excluded from the analysis and do not count towards headcount or FTE figures.

It is important to understand what constitutes full-time equivalence for some PCN roles. For example, it is expected that the average Clinical Director workload in a PCN will equate to around 0.25 FTE and it is likely that any remaining working hours for these staff will be recorded elsewhere. However, when considering the Clinical Director workforce for approximately 1,260 PCNs, 300 FTE staff could be considered to mean that most, if not all PCNs had the expected level of Clinical Director resource in post.

Headcount

Many primary care staff work in more than one GP practice, PCN, ICB or region. When we refer to “headcount”, we mean the number of distinct individuals working for any of these organisations. Headcount figures tend to be higher than full-time equivalence counts because we may include the same person several times in the totals depending on where they work, and whether they are readily identifiable in the data. Another reason headcount figures are higher than counts by full-time equivalence is because we add together the working hours of part-time staff members when reporting full-time equivalent counts, so two people each working at a PCN 2.5 days per week would be reported as two by headcount and one in terms of FTE.

We calculate headcount separately for every reporting level, for example, PCN, ICB or England level, and higher-level headcount figures cannot necessarily be calculated by simply adding together the lower level PCN counts. This is because if the quality of the data is good, we can identify the same person in different organisations so at the higher reporting levels, we count them only once.

As noted, because the data collected about staff providing contracted services is not record-level identifiable data relating to individuals, we cannot calculate headcount figures for this element of the PCN workforce.

Figures were collected for every PCN able to supply data in time. However, we advise users to keep in mind the data quality, completeness and coverage when considering the figures. 

The published figures are effective at the point of the data extract and cannot be used to infer anything about the staffing levels or capacity of the service across the duration of the reporting period.

These figures relate solely to PCN-accountable staff. Although the PCNs can be considered to have a geographical remit that broadly aligns to the overlapping patient catchment areas of the GP practice members, the GP practice workforce is different and is reported separately in the General Practice Workforce series of Official Statistics. In addition to the GP practices, PCN member organisations can be social care or mental health providers and voluntary partners as well as other NHS primary care service providers that differ from traditional high-street GP practices, such as homeless services, or special provision relating to substance abuse. Each of these member organisations will also have their own directly accountable workforces and information about these individuals is not within the scope of this report which relates only to individuals working in, and accountable to, the PCN.

We publish our statistics as quickly as possible after the data extract.

Details of other scheduled publications are announced on our website.

Figures are provided in this release for England and sub-national level.

We have not produced estimates for missing and incomplete data and will not be doing so in future releases. PCNs have the autonomy to decide at a local level which posts to fill and to agree collaboratively on the composition of their workforces according to the particular needs of their patient populations. As a result, it is inappropriate to use data provided by some PCNs to make assumptions about the workforce requirements and patient needs of another PCN which has supplied incomplete information or no data at all.

Some GP practices chose not to join a PCN so not all practices are encompassed by these statistics, but as the workforce counts in this release relate solely to the PCN-accountable staff, this is not a concern. However, figures in this release should not be added to totals published in the GP Workforce or Hospital and Community Health Services (HCHS) Official Statistics, for the data quality reasons already outlined.

There is some risk that individuals are double counted across these and other Official Statistics relating to the NHS workforce because of the contractual arrangements in effect at individual PCN level. For example, it is possible that individuals employed by an NHS trust or ICB but deployed to the PCN will be counted in this report, but also included in totals for their main employer. Further work will be done to investigate how best to reduce this risk, but it is dependent upon good data quality and greater levels of completeness.

Some PCNs include GP practice members from outside the PCN’s ICB. Although this accounts for relatively few practices, this should nonetheless be taken into consideration when considering any ICB-level figures once they are available.

We are aware that seasonal variation affects the primary and secondary care workforces and this may also be an issue for the PCN workforce.

Comments and feedback are welcomed by email to [email protected] or [email protected], or by telephone 0300 303 5678.

To reduce the administrative burden, the NWRS tool includes functionality for GP practices and PCNs to transfer employee records to other NWRS users which will have reduced the data entry burden.

Registered NWRS users input and maintain workforce data in a live system. Once the records exist, the administrative burden is relatively light. We extract PCN workforce data from NWRS on a quarterly basis and users are asked to ensure that the workforce data is up to date in time for each data extract. It is anticipated that this will become a monthly collection in due course, but it is not expected that this will result in unreasonable additional burden for NWRS users.

The standard NHS Digital data security and confidentiality policies have been applied in the production of these statistics. The data contained in this publication is Experimental Official Statistics. The Code of Practice for Statistics is adhered to throughout the publication cycle along with NHS Digital’s Statistical Governance Policy.

All publications are subject to a standard NHS Digital disclosure risk assessment prior to issue and statistical disclosure control was not necessary for this release.