Patients at GP surgeries are less likely to be happy with service provision if there are more non-medical staff in clinical roles, according to a new analysis.

A study by University of Manchester researchers explored the impact on delivery and patients’ experience of healthcare with the introduction of new roles including social prescribers, clinical pharmacists, paramedics and physician associates. They analysed 6,296 English general practices between 2015 and 2019, making it the most detailed study to date, and their findings are published in the latest edition of Social Science and Medicine.

The team used national data to explore the statistical relationship between the workforce composition and ten indicators of accessibility, clinical effectiveness, user experiences and health system costs. Roles were grouped into four categories: GPs; nurses; healthcare professionals (HP), which include clinical pharmacists, physiotherapists, physician associates, paramedics, podiatrists, counsellors, and occupational therapists; and healthcare associate professionals (HAP), which include dispensers, health care assistants, nurse associates, pharmacy technicians, psychological well-being practitioners and social prescribing link workers.

Employment increased over the study period for all the staff groups, with largest increases for healthcare professionals, from an average of 0.04 full time equivalent (FTE) per practice in 2015 to 0.28 in 2019. The smallest increase was in nurses, for which there was a 3.5% growth. While employing more staff in traditional primary care roles, such as GPs and nurses, was positively associated with changes in practice activity and outcomes, there was a negative trend in patient satisfaction, particularly in practices that had employed more HPs.

They found that on average, a one FTE increase in HP staff was associated with a 2.4% drop in overall patient satisfaction. A one FTE increase in HP was associated with a 1.3% drop in patient satisfaction with making an appointment. However, employing pharmacists contributed positively towards some tasks, improving the quality of medicine prescription and reducing the burden of these activities for existing staff.

Lead author Dr Igor Francetic said: “The introduction of new roles to support GPs does not have straightforward effects on service quality or patient satisfaction. In fact, we provide substantial evidence of detrimental effects on patient satisfaction when some health professionals and healthcare associate professionals are employed. Patient satisfaction is a crucial dimension of quality of care, as it contributes to individuals’ willingness to seek care through GPs. There was limited evidence of interaction – in terms of either substitution or complementarity – between the GPs and other roles, suggesting they contribute independently to outcomes and quality in primary care. This goes against the common wisdom that some of these new roles will reduce the workload of existing GPs.”

Urging caution about introducing more different professionals in primary care, he added that many of these new roles require significant supervision from GPs.