Primary Care Network Workforce - 31 March 2020

The PCN data collection module within NWRS was launched at the end of February 2020, which should have allowed PCNs a month to enter, modify and/or update the records. However, the COVID-19 global pandemic placed the entire health and care sector under immense pressure which understandably had a detrimental effect upon the quality of the data.

This is the first time that information about the PCN workforce has been collected. Around 82% of the PCNs had activated user accounts for the NWRS tool by 31 March 2020, and many of these users were already experienced with the GP practice-level submissions.

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 the tool enabled GP practices whose staff were moving some or all of their working hours to the PCN to transfer details of the applicable staff. This allowed the NWRS user in the PCN to import their 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 the following when reviewing the figures:

• Rather than being employed by the PCN, some staff are employed by another NHS organisation, for example a hospital trust or CCG. In such cases, 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.
  While there remains a risk of double-counting individuals across the NHS workforce, very few PCNs were able to provide data for this first collection and any potential issues that could result from counting the same person more than once are partially offset by the very low data completeness and coverage.
• Pooled resource
  • The risk of inflated counts is a particular issue for pooled resource, where no data is collected about individuals and it is not possible to identify individuals or remove double-counted hours from the totals.  This also means that we cannot calculate headcount figures for pooled resource, as we cannot determine how many individuals are covering the service.
  • Because the data collected on pooled resource 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 a physiotherapist pooled resource working an average of 75 hours per week, which equates to two FTE staff. However, we cannot determine from the first 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.

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. However, user feedback and other evidence indicate that the completion of the NWRS was adversely affected by the COVID-19 pandemic and the data coverage and completeness is extremely low, even for a first data collection. This should be taken into consideration when reviewing the figures.

Of the 1252 PCNs active during the first quarter of 2020, 82% had activated their NWRS user account by the end of March 2020 and 188 (15%), across 71 CCGs submitted data. Of these, 182 PCNs provided some record-level information and 13 of those also submitted details about some pooled resource. A further six provided no record-level data but did supply some information about pooled resource.

Of the 182 PCNs submitting record-level data, 52 included details of only a single member of staff, while a further 102 PCNs reported fewer than five. However, it is not clear whether these low counts of PCN staff are because additional people have not yet been recruited, or whether their details could not be entered into the NWRS in time.

The PCN population is still evolving. Several PCNs that were created during 2019 have subsequently merged into a single organisation while others have divided to form several PCNs. Six PCNs closed on 31 March with four new PCNs forming from 1 April 2020; in one instance, a closing PCN split to form two new networks while in the other cases, two PCNs in Liverpool and three PCNs in Lincolnshire closed with each forming a new PCN.

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) updates information on PCNs in arrears on a monthly basis, and includes information on the relationships between practices, PCNs and CCGs. Although some PCNs cross CCG boundaries, the ODS data identifies a single CCG as the PCN “parent” even though some GP practice members may be accountable to a different CCG 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 CCG to the practice’s own CCG should be taken into consideration when reviewing the PCN workforce at CCG-level.

The figures reported in this release are effective as at 31 March 2020. However, because the data are not complete and the coverage is so poor, only England-level counts are available and users should be mindful that these figures are not properly representative of the size of the PCN workforce.

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.

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 1250 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.

Many primary care staff work in more than one GP practice, PCN, CCG 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, CCG 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. However, due to the low data completeness and coverage in this first data collection we are publishing figures at England level only.

As noted, because the data collected about pooled resource 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, due to the low numbers of PCNs able to provide data and because of the low coverage, we are reporting at England level only in this report as lower level figures and geographical analysis by CCG and other areas would not be meaningful.

The published figures are effective at the point of the data extract – 31 March 2020 – and cannot be used to infer anything about the staffing levels or capacity of the service across the duration of the reporting period which is January to March 2020.

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.

This is the first publication of PCN workforce data, which we have published as quickly as possible after the data extract and to coincide with the general practice workforce publication.

Details of other scheduled publications are announced on our website.

Figures are provided in this release for England only and no data are available at sub-national level due to the data quality, completeness and coverage issues already outlined.  

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.

This is the first collection of the PCN workforce data and there are severe issues in terms of the completeness and coverage although the data quality is expected to improve for future collections.

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 CCG 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 CCG. Although this accounts for relatively few practices, this should nonetheless be taken into consideration when considering any CCG-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. However, the COVID-19 pandemic and associated data quality issues, along with the fact that this is the first collection of this data mean that further collections and releases of data will be required before any such seasonal effect can be quantified.

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 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.