Identifying the future risks for Somerset's GP workforce

The new GP Workforce Reporting tool enables Somerset CCG to accurately predict medical and nursing workforce pressures.

The challenge

Somerset is one of 11 Sustainability and Transformation Partnerships (STP) in England with a high proportion of GPs who are aged over 55 and/or have made the decision to retire. To support local workforce planning to mitigate this issue it is essential to have a detailed understanding of the workforce in terms of age, location, job roles, and the number of hours worked. However, there has historically been uncertainty surrounding the data sources used and also with emerging datasets that could be used going forward. With many years of experience working with NHS primary care information combined with GIS software and spatial data, the Geographical Intelligence and Mapping team provides both in-depth analytic tools and Geographic Information services to NHS organizations in England. They have developed innovative solutions to support health commissioners in their day-to-day business.

The approach

We were initially asked to reappraise an existing report which described the Somerset GP workforce. There was a strong understanding of primary care data within the team, but a growing awareness that old data sources are no longer entirely reliable and that new ones were becoming available. The team undertook a thorough audit of the existing data and, working closely with Somerset CCG, brought together and validated multiple data sources to produce a new report evidenced from data sources that the customer could have confidence in. A strong working relationship was developed through working collaboratively with the customer.

The team is an approved Primary Care data processor for NHS England and delegated commissioning CCGs and is the only NHS organization that is a licensed partner with Ordnance Survey, the national mapping agency.

The results

  • GP data capture - a suite of products were developed allowing benchmarking to compare Somerset CCG with its peers and provide valuable insights into the future risks facing the GP workforce in Somerset, many of which were concerned with the number of practitioners approaching retirement age. This has led to the identification of practices and localities with the greatest workforce pressures and the CCG is now using this information for more proactive engagement with them.
  • Our support has helped the CCG gain, for the first time, an accurate and up-to-date picture of current and future workforce pressures by workforce position. This has required close working with members of the Somerset CCG’s Primary Care team to address data quality issues, identify data sources and provide reassurance and in-depth analysis and modeling.
  • Using the NHS Digital Workforce Minimum Data Set (WMDS), the team developed a Somerset GP Workforce Reporting tool which gives details of the various workforce roles (GP Provider (Partner), GP Employee of the Practice (Salaried), GP Retainer and Nurse types – Practice nurses, Advanced Nurse Practitioner.
  • The team delivered a suite of products. At the core is the GP Workforce Report, now updated on a quarterly basis. Regular reports will be produced twice yearly describing nursing, direct patient care roles, and administrative roles.
  • The reports have been illustrated using maps, as shown below, and Deep Dives have been undertaken to further investigate topics of concern highlighted by the reports.

Deep Dive topics include:

  • Investigation of the list sizes of practices in Somerset over time, and detailed analysis of the movement of patients between practices
  • Investigation of the extent to which Practice Boundaries overlap. This was important to facilitate discussions between practices who are considering closer joint working or mergers with their natural neighbours
  • Investigation of predictions for population growth in Somerset. Population growth means more demand for services.

Below is an example of the key information presented in the Workforce Reports. It shows how the Patient to Full-Time Equivalent (FTE) GP ratio varies across practices in Somerset. The practices with the bigger proportion of patients per GP are highlighted in red. The national average is a ratio of approximately 1:2,000. Where the ratios are reported to be significantly above this, it gives the CCG a reason to have a conversation with the practices.

Headline topics were presented as maps including practice risk factors such as retirement age (shown below is an example), practice list size, changes to patient list sizes, GP headcount at each practice, GP to patient ratio in five years, gain or loss of GP full-time equivalent relative reduction risk, and a composite ‘Total Risk’.

Below is an extract that shows each GP practice in the Bridgwater Bay Locality represented by a pie chart. The sizes of the pies represent the GP headcount at each practice. The red wedges and text show the percentage of GPs who are over 50 and likely to retire in the near future.

 

The CCG Primary Care team was further supported in their planning and analysis with additional SCW HealthGIS tools such as the interactive online GP Map Plus tool (screenshot below). This tool allows practices to investigate the distribution of their practice population, see age profiles and practice boundaries, and supports patient registration by plotting patient location on the map in relation to the surgery. Of particular use to commissioners also, and supporting the GP Forward.

The view is that multiple practices and populations can be combined and viewed together which enables them to model scenarios of practice mergers or hubs and the tool dynamically creates a combined practice with merged boundaries and patient lists on the map.

The Somerset GP workforce tools provide valuable and reliable information to inform discussions and improve decision-making. The CCG has found the reporting tools to be useful for the identification of key risk factors and development of their GP Practice Workforce Strategy and Strategic Planning:

  • Concerns with the fragmented nature of workforce information and data quality issues have been addressed
  • Confidence in workforce information has been increased
  • The tools have been used to engage with GP practices, the Local Medical Committee, and other stakeholders
  • Information from the reports are published as part of the CCG’s quarterly GP bulletins
  • Work is underway to develop extensive skill mix (GPs, Nurses, other staff) reports which take into account all relevant practice workforce roles. This has become a key strategy for primary care to broaden the skill mix in general practices
  • In-depth analysis and visualization using mapping tools have helped Somerset CCG to design service development such as locality boundary changes. GP practices are now also used to using these new techniques to help them consider such changes and development
  • The now established methodologies will be shared with other CCG organizations and NHS England to develop best practice
  • There is potential to extend the workforce reporting and mapping to other STPs and CCGs who are already showing interest in this information. 

"The SCW Geographic Intelligence and Mapping team have helped us move to a position of confidence in our primary care workforce data and having confidence in the data has enabled us to share it with practices and other stakeholders. We are now able to begin planning viable workforce strategies to address our workforce challenges. I have found the team to have exceptional skills in managing, combining and analysing complex sets of data, in mapping and presenting data in a number of engaging more visual ways, their response and patient style of working and their delivery of promised outputs" - Andy Hill. Head of Primary Care Development, Somerset CCG.

For more information or to discuss, please contact This email address is being protected from spambots. You need JavaScript enabled to view it. via This email address is being protected from spambots. You need JavaScript enabled to view it. 

 

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