New OHE Research Funding: Improving Labour Productivity in Primary Care

OHE has been awarded a research grant by the Health Foundation’s Efficiency Research Programme. The award funds a three-year project that aims to define an accurate measure of labour productivity in primary care and to identify its determinants, including workforce skill mix, technology, and patient characteristics. The project is a collaboration with the University of Oxford and the Royal College of General Practitioners’ Research and Surveillance Centre (RCGP RSC).

NHS England’s General Practice Forward View makes a number of commitments to reverse historic underinvestment in primary care, including a £2.4 billion investment by 2020/21 and recruitment of additional medical workforce to reverse current understaffing trends. This investment aims to tackle the increasing pressure on primary care services, driven in part by a decline in the number of GPs per head of population since 2009. Despite this investment, it is important that there is a continual improvement in general practice efficiency and effectiveness to prevent a growing population with increasingly complex and multimorbid patients from eroding this investment.

A consensus has emerged on the areas where general practice productivity could be increased, as summarised in the Forward View and by the Primary Care Workforce Commission. For example, greater use of workforce enhancing technology, optimising skill mix, and greater use of role substitution. However, at present, there are few concrete recommendations in these areas.

Using a multimethod approach, spanning qualitative and quantitative research methods, this project will fill the current gaps in knowledge by delivering evidence-based recommendations for improving performance among practices and on the determinants of primary care labour productivity.

A systematic literature review will inform the development of new measures of labour productivity in primary care that can account for both the quality of care and multiple output dimensions. Econometric analyses will then shed light on questions around the optimum staffing levels and skill mix, the trade-off between efficiency and effectiveness, the potential impact of technology in shifting the primary care production function, and the scope of using better triage alongside skill mix improvements. This analysis will employ data from the RCGP’s RSC, a high-quality dataset of routinely collected patient and practice level information from approximately 410 GP practices in England.

Findings from this research have the potential to deliver immediate policy impact, given the timing of the NHS Forward View implementation. A reproducible algorithm for measuring primary care labour productivity will also be released to enable ongoing performance measurement and long-term service improvement across the entire primary care sector.

The team contributing to this research includes Graham Cookson, Patricia Cubi-Molla, Margherita Neri and Bernarda Zamora from the OHE and Simon de Lusignan from the University of Oxford.

For more information about this project, please contact Graham Cookson.


Related research

Elkomy, S. and Cookson, G., 2019. Cheap and Dirty: The Effect of Contracting Out Cleaning on Efficiency and Effectiveness, Public Administration Review, 79 (2): 193-202. DOI.

Elkomy, S. and Cookson, G., 2018. Performance Management Strategy: Waiting Time in the English National Health Service, Public Organization Review. DOI.

Cookson, G. and Laliotis, I., 2018. Promoting normal birth and reducing caesarean section rates: An evaluation of the Rapid Improvement Programme. Health economics, 27(4), pp.675-689. DOI. RePEc.

Sandall, J., Murrells, T., Dodwell, M., Gibson, R., Bewley, S., Coxon, K., Bick, D., Cookson, G., Warwick, C. and Hamilton-Fairley, D., 2014. The efficient use of the maternity workforce and the implications for safety and quality in maternity care: a population-based, cross-sectional study. Health Services and Delivery Research, No. 2.38. DOI.

Zamora, B., Gurupira, M., Sanchez, M.R., Feng, Y., Hernandez-Villafuerte, K., Brown, J. and Shah, K., 2019. The value of international volunteers experience to the NHS. Globalization and health, 15(1), p.31. DOI

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