General Practice Workforce 30 November 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 (FTE) 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 NWRS 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 the 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 tend to 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 details of any new staff members and other 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 one or more recurring weekly or monthly sessions. 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 will 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 along with the total number of hours worked during the entire reporting period. Until October 2020, this meant practices provided information about these “infrequent” locums and their total 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.

Clearly, we would expect the total hours worked by the infrequent locum cohort to be lower when collecting data monthly than when we extracted on a quarterly basis, perhaps by around two thirds. However, the total infrequent locum worked hours in October 2020’s data extract was much less than a third of September’s quarterly total. Although the recorded infrequent locum worked hours increased in the November extract, they were still significantly lower than might be expected when considering previous quarters’ usage. In addition, we are aware that a far lower percentage of GP practices logged onto the NWRS during October and November 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 and 30 November. 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 and November.

We are aware that locum usage was significantly reduced, particularly from March 2020 onwards 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 have evidence that the numbers of general practice appointments delivered during October and November were closer to the expected levels (https://digital.nhs.uk/data-and-information/publications/statistical/appointments-in-general-practice) and have cause to believe that the large decrease in infrequent locum FTE is partly a result of data completeness and coverage issues rather than necessarily being indicative of reduced locum usage.

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. However, we are mindful of the burdens that practices face in the normal course of events and that COVID-19 and the vaccination programme are 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. This process is complicated by the fact that we have never before collected GP workforce data for October or November and have only quarterly trends to inform our monthly estimates.

Where practices were able to provide information on infrequent locums working for them in November, this has been included in the FTE counts. We have estimated CCG-level figures for the missing FTE and allocated them on a pro-rata basis according to patterns of usage and infrequent locum distribution seen in the quarter up to 30 September 2020.

Infrequent locums and headcount

The use of estimated infrequent locum records could have the effect of inflating the overall GP and staff headcounts. For example, an identifiable GP working in two different roles such as a locum and a salaried GP would be counted once in the “All” headcount total and separately within each of the locum and salaried GP categories. However, the use of estimated locum records in place of identifiable records means that, if the locum GP being estimated for also works in another job role – such as a salaried GP – they will still be counted separately within each GP type but twice in the “All GP" headcount, since they cannot be identified as being the same person. 

Furthermore, while FTE estimates are more straightforward because FTE is calculated as a weekly measure, estimating infrequent locum headcount for a single month is problematic as the data underpinning such estimates currently applies to a three-month period and we have no information about how many months each individual infrequent locum may have worked during the quarterly period (one, two or three). Consequently, there is great uncertainty about the number of people that may be expected to appear in a single month of good quality infrequent locum data.

For these reasons, headcount figures have not been included within this release. We are exploring options for a robust estimation model for missing locum GP records which mitigates these problems and will release headcount figures as soon as we are able to do so. 

We are 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 December'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 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.