Administrative data to evaluate new models of primary care

Primary care remains at the centre of NHS plans to meet current demographic challenges. Yet primary care is poorly prepared. Not only are the structures unsuitable (e.g. small practices, limited premises), but recruitment to and morale in general practice are poor with many practices struggling to meet the expectations placed on them. Against this background a wide range of initiatives have been developed to try and adapt general practice. Some of these focus on modifications to current structures, including new approaches to skill-mix and the formation of larger groups (clusters and federations) to increase the scope of what general practices can offer.  Other initiatives are more radical in design, including the entirely new models of organisation proposed in the recent NHS Five Year Forward View.

We will bring together a wide range of sources of data on general practice to enable us to evaluate the impact of these changes on patient care. These data will have national coverage and be available over a long time-period. We have developed a theoretical model to link the structure and function of primary care to patient outcomes. The model identifies a wide range of factors including the importance of the practice organisation, the employment status of GPs (e.g. salaried or sharing partners), GP turnover, work stress, autonomy at work, and job satisfaction. Measures of these are already available or can be derived from existing sources of data.

The major aim of this study is to establish an infrastructure for future grant applications and evaluations by creating an enabling resource for researchers requiring data on general practices (e.g. to identify controls for evaluation of major policy initiatives). To demonstrate what is possible, we will answer three important policy relevant research questions on working conditions, GP turnover and practice ownership during the course of this project.