Improved staffing levels at GP practices in England do not lead to faster appointments for patients, researchers report today.

Research carried out by the University of Manchester analysed practice-level data on 6,284 general practices in England and appointments made between August 2022 and October 2022. The data contain monthly counts of attended appointments at each practice by staff type – GP or other care professional, such as dispensers, link workers and practice nurse – and time between booking and appointment, covering 98.7% of practices and 99.8% of all registered patients in England.

The team, led by Tianchang Zhao, conducted multivariable regression analyses, relating population age and deprivation, numbers of GPs, nurses, and other care professionals, and organisation characteristics to numbers of appointments by staff type and to proportions of appointments on the same or next day after booking.

Writing in the British Journal of General Practice, the team writes that appointment levels were higher at practices serving rural areas, while practices serving more deprived populations had more appointments with other care professionals than GPs. On average, practices delivered 1,414 appointments per 1,000 registered patients in the three-month study period. There was a significant variation between practices in the volume of appointments per 1,000 registered patients and in staffing, with an average of 0.58 FTE GPs per 1,000 registered population and 0.24 FTE other care professionals. 49% of appointments were seen on the same or next day of booking. However, this figure was higher, at 63%, for GP appointments.

One additional full-time equivalent (FTE) GP was associated with an extra 175 appointments over three months. Additional FTEs of other staff types were associated with larger differences in appointment rates (367 appointments per additional nurse and 218 appointments per additional other care professional over three months). There was evidence of substitution between staff types in appointment provision. Increased staffing levels are associated with more appointment provision, but not speed of appointment availability, the researchers say. New information on activity levels has shown evidence of substitution between GPs and other care professionals in appointment provision and demonstrated additional workload for practices serving deprived and rural areas.

They write: “The study found that patients registered with practices with more staff per 1000 population have more appointments. It also found that the variations between practices follow expected patterns in terms of appointments by staff type, with more GPs associated with more GP appointments and more other staff associated with more appointments with other staff. The study found substitution between staff types in appointment volumes, because numbers of appointments delivered by other staff groups was lower in practices with higher numbers of FTE GPs per 1000 patients (and vice versa).

“In terms of additional appointment volumes per FTE, the study found that nurses were associated with the highest number of additional appointments, followed by other direct patient care professionals. Grossing up to annual figures would suggest one additional FTE GP would be associated with 1,193 additional appointments with GPs or a net of 700 total additional appointments per year, after accounting for staff substitution in the provision of appointments. One additional FTE nurse or other care practitioner would be associated with a net of 1468 and 874 additional appointments per year, respectively.”

The authors conclude: “The analysis has provided an interesting snapshot of appointments activity and future work should track changes over time. Future research should also seek to explain these differences, especially why deprived populations have more appointments with other care professionals but not with GPs. The consequences for patient and staff health and wellbeing should be evaluated.”