Response to the consultation on changes to the General and Personal Medical Services, England Statistics,

Response to the consultation on changes to the General and Personal Medical Services, England Published May 2015

We are the trusted national provider of high-quality information, data and IT systems for health and social care. www.hscic.gov.uk enquiries@hscic.gov.uk @hscic Responsible statistician: Kate Bedford, Programme Manager Workforce and Facilities Team Health and Social Care Information Centre Version: V1.0 Date of publication: 29 May 2015 2 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Contents Executive Summary 4 Introduction 4 Purpose and Audience 4 Points to note 5 Key Findings 6 Detailed Survey Results 11 About the respondents 11 Changes to underlying methodology and categorisations 12 Q1: FTE cap for General Practitioners with multiple contracts with default hours 12 Q.2: General Practitioners excluding Registrars and Retainers category 14 Q.3: GP Registrars paid via the Electronic Staff Record System (ESR) 16 Q4: Including statistics for GPs working in other settings 17 Changes to summaries and commentary 19 Q.5: Changes to publication summary and commentaries 19 Increasing the statistics available for practice staff 21 Q.6: Mirroring the current General Practitioner statistics 21 Changes to the frequency and timing of publication 23 Q.7: Sub-annual publications 23 Q.8: Timing of publications 26 Presenting the statistics 27 Q.9: Enhancements to the clarity, usability and relevance 27 Further comments 33 Appendix 1: Example extracts from future publications 34 Copyright 2015, Health and Social Care Information Centre. All rights reserved. 3

Executive Summary Introduction The Health and Social Care Information Centre (HSCIC) currently produces an annual publication of General and Personal Medical Services statistics (GP Census). The GP Census records numbers and details of GPs in England along with information on their practices, staff, patients, and the services they provide, showing a snapshot of the general practice workforce as of the 30 th September and change over the last ten years. Further information relating to this and the most recent publication can be found here. The HSCIC has consulted users on changes to the way information is used to produce these statistics and how the data are sourced, processed, defined and presented. These changes are intended to give users a better understanding of how General Practice is resourced and allow them to plan for future workforce needs more effectively. The consultation has captured users requirements that will inform changes following the future implementation of the Workforce Minimum Dataset (wmds). More information relating to wmds can be found here. This publication is linked to the NHS Hospital and Community Health Service Workforce Statistics in England for Medical and Dental staff (Medical and Dental Census). Information related to this and the most recent publication can be found here. A separate consultation on the Medical and Dental Census will begin shortly. Purpose and Audience The purpose of the consultation was to gather views and opinions regarding possible future changes to the General and Personal Medical Services statistics (GP Census) and the Workforce Overview Publication summary. The feedback provided will be used to inform any future development of these publications. Specifically we consulted stakeholders regarding: 1. Changes to the underlying methodology and categorisations 2. Changes to the content of summaries and commentary included within the publication 3. Increasing the statistics available on practice-based colleagues other than General Practitioners and bringing them into line where possible with those produced for General Practitioners 4. Changes to the frequency and timing of publication 5. Enhancements to the clarity, usability and relevance of the presentation of statistics. 4 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

The consultation was aimed at: Any current or potential users of the statistics produced including the Department of Health (DH), the British Medical Association (BMA), NHS England, Health Education England (HEE), Local Education and Training Board members (LETBs) and others. It is important that these stakeholders are aware of any alterations or additions to the statistics being made available, and have the opportunity to participate in the development of these changes. Experts in NHS workforce and in workforce planning more widely. It is important to involve this group of stakeholders, in addition to the reasons above, in order to provide additional scrutiny of the methodology and reasoning used in producing these statistics, and to contribute expert knowledge and best practice in their development. General Practitioners, Practice Managers and other staff working within General Practice. As the source of and subject of this publication in is crucial that it of most use to those involved in the delivery and development of General Practice. Any other interested party, including members of the public, wishing to ensure that the statistics we produce we produce are useful, understandable and focussed on providing the best possible information to all users. Points to note Figures in the following response may not sum to 100% due to rounding. All tables in the following use scores ranging from 1 to 5, indicating Not Useful to Very Useful or No Interest to Very Interested. The commentary associated with these tables, ranks scores 1 and 2 together to indicate negative responses and 4 and 5 together to indicate positive responses. In the event that one or more categories have an identical ranking score, we will take the category that has the lowest 1 score or highest 5 score, to be the least/most popular category. The above applies to all tables unless otherwise stated within the table commentary. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 5

Key Findings Full details of the responses to each question are given in the Detailed Survey Results section of this document. In addition, examples of how these results will be implemented in future publications can be found in Appendix 1. Q1: FTE cap of 1.00 for GP s and its impact within publications Just over a third, 38% agreed with the proposed capping of the 1.00 FTE. 19% of respondents thought 1.28 FTE was most fair and accurate and 42% did not know. The majority, 42% didn t know whether it would have a negative impact on them, within the publication, if previous publications were not re-worked. 31% would not be affected by the proposed change and 27% advised it would have a negative impact. HSCIC responses: The proposal will be implemented. The HSCIC will cap the FTE for an individual GP with multiple contracts to 1.00 FTE. In the next publication the 10 year time series will be re-based where possible to reflect the new 1.00 FTE methodology. Q.2: General Practitioners excluding Registrars and Retainers category Responses to which category was most useful were split, with 38% of respondents considering the Practitioners excluding Registrars and Retainers and Practitioners excluding Registrars, were equally useful. The majority, 35%, did not know whether changing from Practitioners excluding Registrars and Retainers to Practitioners excluding Registrars, without reissuing previous publications would have a negative impact on them. 31% of respondents advised that it would have a negative impact on how they use the statistics and 27% advised that it would not impact them. HSCIC responses: As both categories would be equally useful, we will include both categories within the publication. As the responses were similar, we will include both categories within the publication and where possible re-work the 10 year time-series. Q.3: GP Registrars paid via the Electronic Staff Record System (ESR) The majority would not be affected by the proposal to remove GP Registrars from the ESR and include them within the GP Census, with 50% of respondents selecting No. 35% stated they did not know whether this would have a negative impact on them and the remaining 15% of respondents stated it would have a negative impact on them. As the majority would not be affected by this proposal, the HSCIC will implement the change. 6 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Q.4: Including statistics for GPs working in other settings The majority of respondents, 46%, would find it very useful to have the figures for GPs working in other settings. Whereas, 23% of respondents stated they would not find it useful. The majority, 65%, stated that the proposed change to include these statistics in future, but without reissuing any previous publications would not have a negative impact on them. 12% of respondents advised that it would have a negative impact on them, 19% advised they do not know what impact a change would have them. HSCIC responses: 65% of the responses were in the Useful and Very Useful ranges (based on 4 and 5 scores). We are unable to include these figures in the September publication. However, we will make these available in future publications (dates to be announced). As the majority would not be affected by this proposal, the HSCIC will implement the proposal. The amendments will be distinct and clear and we will aim to re-base previous years data in order to provide a comparable time series. Q.5: Changes to publication summary and commentaries Of those who have used the publication before, 42% of respondents have used the information provided in the summary and 12% have not. Respondents were given a list which contained 15 possible categories and statistics that could be included in the publication. The majority of respondents across all categories were Very Interested in seeing the statistics listed, included in the publication summary, with 5 score ( Very Interested ), receiving 49% of all responses. 1 Score ( No Interest ), received 16% of the responses and 4% did not answer. HSCIC responses: Of those who use the publication, 42% (11), use the publication summary, which illustrates the need to continue to produce this analysis. We will aim to preference the most popular categories and statistics within the publication, based on these responses received. Q.6: Mirroring the current General Practitioner statistics The majority, 69% of respondents, stated that the proposed additional granularity of statistics for practice-based staff would be of interest. However, it would not be of interest to 19% of respondents and the remaining 12% did not know whether it would be of use. The largest number of respondents 46% (12) thought there were other useful ways the statistics could be broken down in addition to those already provided within the General Practice Statistics. 31% thought the opposite, 19% of respondents did not know either way. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 7

HSCIC responses: This proposal will be implemented. Nurses and Direct Patient Care staff will be included in the September 2015 publication. Administrative and Other staff will be included in the March 2016 publication. 46% of respondents would like to see other ways the statistics could be broken down. The most common suggestions were; similar breakdown to that of GPs, Country of Qualification and length of service. The HSCIC will implement this proposal. Q.7: Sub-annual publications An equal number of No and Yes replies were submitted, with 42% of each and 12% of respondents did not know whether a smaller publication midway through the year, would be of use to them. Respondents were given a list which contained 6 items which could be included in a mid-year publication. The majority, 40%, were very interested in seeing the items listed included within any mid-year publication. 6% either did not know or did not answer the question and 23% had no interest in seeing the items included. The item most respondents were interested in seeing is the Practice Level dataset. The majority, 42% of respondents did not feel that more detailed thematic analysis would be of use, within the mid-year publication. 35% of respondents thought it would benefit them and 23% did not know either way. HSCIC responses: The majority of respondents who did not see a mid-year publication as useful to them cited the reason for this as the increased burden on practices, from moving to a six-month collection cycle. The burden has been assessed by BAAS and has been approved. An online system has been built to help reduce the burden of data collection and will be easier than the previous manual collection method. Further information relating to the burden of the collection, can be found at; www.hscic.gov.uk/baas We will look to proceed with a smaller mid-year publication and will consult with stakeholders. The Yes and No results were similar. We feel based on these results and comments there are still some stakeholders who would benefit from this analysis. Therefore, we will aim to include it in future publications where possible, but it will be given a lower priority than other elements. Practice Level Dataset and Anonymised GP Level Dataset, will be included in the mid-year publication as these were the highest ranked (based on 4 and 5 scores). We will aim to work through the others in order of popularity. 8 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Q.8: Timing of publications We proposed that following the development and delivery of the wmds we explore opportunities to improve the timeliness of this publication. This question does not have results, however, comments were requested. The most common responses were to have more timely data and the burden on practices should be kept to a minimum. In line with the Code of Practice, we will aim to publish the data in a timelier manner. Information from the 31 March 2015 collection will be published during September 2015. Following this we will explore opportunities to reduce the time between collection and publication. Q.9: Enhancements to the clarity, usability and relevance Respondents were given a list which contained, Summary Statistics, Interpretation of these statistics and Raw data and were asked to score them in terms of usefulness. 33% of respondents thought the current elements of the publication were Very Useful, (based on 5 scores). 13% did not know how useful the current elements of the publication were. More respondents felt the Summary Statistics category was the most useful of the three. Respondents were given a list which contained 13 possible categories that could be included in the publication. The majority of would be very interested in seeing the statistics broken down across most categories. The one that bucks this trend is the response to the Recruitment Source, where the majority chose No Interest. The categories that respondents would be most interested in seeing the statistics broken down by are, Working Hours (full/part time etc.), Age Band and Practitioner Type / Job Role. 8% of respondents did not know whether they would be interested in using interactive tools to create bespoke visualisations and summaries. The other 24 were split 50/50, on whether they would be interested or not. The majority, 50% of respondents would not be interested in seeing alternative visualisations in the publications. 8% of respondents would like to see alternative visualisations and 23% did not know either way. 19% of respondents did not know how useful the data files are in their current format. Of the two options, the aggregated Practice Level data was voted as slightly more useful than anonymised Individual Level data. Respondents were given a list which contained 13 categories that could be included in the data files. The majority of respondents, 42%, were very interested to see the categories listed, included in the individual and practice level data files, (based on 5 scores). This compares to 22% who had no interest in seeing these, (based on 1 scores). 5% do not know either way, whether they would be interested. The categories most respondents would be interested in are; Working Hours (full/part time etc.) and Length of Service. Respondents were least interested in, Recruitment Source. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 9

HSCIC responses: When we rank the three publication elements, all three are similarly regarded as very useful. As a result we will continue to include a mixture of all elements for different stakeholders. There is clearly a need and desire for the analysis of raw data. We will include categorisations within the publications starting with the most popular, working through and publish what we can. Working Hours (full/part time etc.), Age Band and Practitioner Type/Job Role, were ranked highest. As there is some demand for an interactive tool, we will make HSCIC tools available to aid analysis and will announce when these are available. We are not going to add any alternative visualisations into the publication. The publication will remain simple and limited to what is needed. Given how useful both data files were considered, they will continue to be included in the publication and development of them will be a priority. New categorisations will be included based on respondents preferences. 10 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Detailed Survey Results The HSCIC received 26 consultation responses in total. All 26 have been analysed and feature within this publication. Of the 26 submissions being analysed, 62% (16), responses were on behalf of individuals and 38% (10), were responses from organisations or groups and 50% (13), were currently, or had used previously the publication. About the respondents Figure 1a: Number of respondents by organisation type. Source: Health and Social Care Information Centre The majority of responses were from a General Practice Providers, accounting for 50% of responses. Health Education England and HEE Local Education and Training Board members accounted for 12% of responses each. Other, represents one response from the General Practice Committee (GPC) and one response from the British Medical Association (BMA). Primary reason for the respondents interest in the statistics The majority 92% (24), of respondents provided details for their interest in these statistics. These reasons varied and ranged from commissioning of services and training, workforce planning, strategy and policy, and service delivery. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 11

Changes to underlying methodology and categorisations Q1: FTE cap for General Practitioners with multiple contracts with default hours There are a number of GPs with more than one contract where all of their contracts are defaulted to the equivalent of full-time. The current method of accounting for this issue is to cap the total amount any one GP can be assumed to be contracted to work across all their contracts at 1.28 FTE. We propose that when a GP has multiple contracts all defaulted to full-time hours that we assume that they are contracted to the equivalent of 1 FTE across all contracts in total, with this 1 FTE then apportioned equally across all practices they are contracted to. Question 1.1: When a General Practitioner is contracted to work in multiple practices with all of those practices reporting their contracted hours as equivalent to full-time, which FTE cap do you consider to be the most fair and accurate reflection of the likely total FTE for that Practitioner? Figure 1b Results: Source: Health and Social Care Information Centre The majority 42% did not know which FTE cap was the most fair and accurate. 38% of respondents thought that 1 FTE was the most fair and accurate and only 19% thought that 1.28 FTE was the best solution. Summary of comments: 16 comments were received. Using 1 FTE would be better for analysis, but there was a variance within practices on how many sessions are classed as full-time. These ranged between 8 and 11 sessions. 12 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

As 38% of respondents thought 1 FTE was the most accurate, this will be adopted and previous years data will be re-worked to allow comparable data. Question 1.2: If we were to change the cap to 1 FTE and reflect this in future publications in both current and historical workforce statistics, but without reissuing any previous publications, would this change have a negative impact on you based on how you currently use these statistics? Figure 1c Results: Source: Health and Social Care Information Centre The majority, 42%, didn t know whether it would have a negative impact on them. 31% respondents said it would not impact on them and 27% stated it would. Summary of comments: 11 comments were received. The overriding trend was a concern regarding the consistency of the time series trends, if previous publications were not reissued. In the next publication the 10 year time series will be re-based where possible to reflect the new methodology. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 13

Q.2: General Practitioners excluding Registrars and Retainers category We would like to understand your views on the usefulness of the Practitioners excluding Registrars and Retainers category. Retainers are fully qualified GPs whose contribution to treating patients within the practice may be considered equivalent to other Practitioners once their reduced contracted hours is taken into account. We propose that the Practitioners excluding Registrars and Retainers category be replaced by a Practitioners excluding Registrars category. Some statistics for Retainers specifically would still be available in the Practitioner-type break downs as currently. Regardless of the outcome of this proposal, the statistics provided for the All Practitioners category, including GP Providers, Salaried/Other GPs, Registrars and Retainers, would remain unaffected. Question 2.1: For your purposes in using these statistics, which category would be most useful to you? Figure 2a Results: Source: Health and Social Care Information Centre The responses to which category was most useful were split equally between, Practitioners excluding Registrars and Practitioners excluding Registrars and Retainers and both received 38% of responses. 19% of respondents who completed the questionnaire did not know which category would be most useful and 4% did not answer. Summary of comments: 8 comments were received. The majority of comments stated GP registrars are not yet qualified GPs and should not be counted as practitioners. 14 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

As the Practitioners excluding Registrars and Retainers and Practitioners excluding Registrars received the same number of responses, we will publish both categories. Question 2.2: If we were to change the category from Practitioners excluding Registrars and Retainers to Practitioners excluding Registrars, and were to reflect this in future publications in both current and historical workforce statistics, but without reissuing any previous publications, would this change have a negative impact on you based on how you currently use these statistics? Figure 2b Results: Source: Health and Social Care Information Centre The majority, 35%, did not know whether the changes would have a negative impact. 31% of respondents advised that it would have a negative impact on how they currently use the statistics, 27% advised it would not impact them and 8% did not answered. Summary of comments: 12 comments were received. The majority were concerned about the potential for errors and confusion, adding that previous publications would need to be re-based and clearly explained. As the Yes and No responses were similar, we will publish both categories. In addition, where possible, we will re-work the 10 year time-series. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 15

Q.3: GP Registrars paid via the Electronic Staff Record System (ESR) Users currently have to consult both the GP Census and the Medical and Dental Census publications in order to gain a complete understanding of the numbers of GP Registrars. We propose that those GP Registrars recorded within the Electronic Staff Record System (ESR) be removed from the Medical and Dental Census and included in the GP Census. Question 3.1: If we were to remove GP Registrars recorded within the Electronic Staff Record System (ESR) from the Medical and Dental Census and include all GP Registrars in the GP Census, would this change have a negative impact on you based on how you currently use these statistics? Figure 3a Results: Source: Health and Social Care Information Centre The majority would not be affected by this proposed change, with 50% of respondents selecting No. 35% stated they don t know whether this would have a negative impact on them and the remaining 15% of respondents stated it would have a negative impact on them. Summary of comments: 12 comments were received. The majority of the comments were that the change would be a good idea, but concern was raised about the need for a consistent time series and previous data re-based. 50% (13) of respondents advised this wouldn t have a negative impact on them. Therefore, we will look to progress this change. 16 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Q4: Including statistics for GPs working in other settings This publication does not include GPs working in Prisons, Army Bases, Educational Establishments, Walk-In Centres, Out of Hours Services or Specialist Care Centres including Drug Rehabilitation Centres. We propose that where possible we include statistics relating to GPs working in other Primary Care settings, such as Walk-In centres, Out of Hours services or institutions. These would be reported separately to those for GPs in traditional general practice settings to maintain visibility of those services specifically, but in a format that would allow users to combine the figures for all settings to gain an understanding of the wider GP workforce. Question 4.1: For your purposes of using these statistics, would the inclusion of figures for GPs working in other settings be useful to you? Figure 4a Results: Source: Health and Social Care Information Centre The chart shows that the majority of respondents, 46%, would find it very useful to have the figures for GPs working in other settings. Whereas, 23% of respondents stated they would not find it useful and 8% did not know either way. Summary of comments: 12 comments were received. The main theme of which was that it would help to include the wider GP labour market, which in turn would help understand all GP services and assist with workforce planning. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 17

65% of the responses were in the Useful and Very Useful ranges (4 and 5 scores). We are unable to include these figures in the September publication. However, we will make these available in future publications (the dates are to be announced). Question 4.2: If we were to include these statistics, and were to reflect this in future publications in both current and where possible for historical workforce statistics, but without reissuing any previous publications, would this change have a negative impact on you based on how you currently use these statistics? Figure 4b Results: Source: Health and Social Care Information Centre The majority, 65% of respondents stated that the proposed change would not have a negative impact on how they use the statistics. 12% advised that it would have a negative impact on them, 19% of respondents advised they don t know whether the change would have a negative impact on how they use the statistics and 4% did not answer the question. Summary of comments: 8 comments were received. The majority of comments were that the amendments would need to be, separate, distinct and clear. Also, the previous publications would need to be re-based, in order for the time series to be consistent. 65% (17), of respondents, advised this wouldn t have a negative change. As such, we will include these statistics. The amendments will be distinct and clear and we will aim to re-base previous years data in order to provide a comparable time series. 18 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Changes to summaries and commentary Q.5: Changes to publication summary and commentaries We provide a summary of the key statistics and messages that can be drawn out from the main body of the publication. These key statistics and messages are based on our understanding of key themes that may be of interest to users of our publications. We propose that the content and format of the summary are reviewed to ensure that they are in line with the changing requirements of users. In future we would look to take advantage of the increased granularity of information available for Nurses and other practice staff following the development and delivery of the wmds. As part of this review we would include all other text describing the statistics in the publication as a whole. Question 5.1: Do you currently use the information provided in the publication summary? Figure 5a Results: Source: Health and Social Care Information Centre Of those who have used the publication before, 42% of respondents, stating they have used the information provided in the summary. 12% have not used the information, but have seen the publication summary. 46% of respondents have not used this publication before. Summary of comments: Comments were not requested for this question. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 19

Of those who use the publication, 42% (11) of respondents use the publication summary, which illustrates the need to continue to produce this analysis. As such, this will continue to be included. Question 5.2: How interested would you be in seeing the statistics below included in the publication summary? Table 5a No Interest Very Interested 1 2 3 4 5 Don't know Not Answered FTE 15% 4% 0% 12% 62% 8% 0% Headcount 19% 4% 0% 12% 58% 8% 0% Registered Patients per FTE 12% 4% 4% 15% 54% 8% 4% By practitioner type / job role 12% 4% 12% 12% 54% 8% 0% By age band 15% 4% 8% 15% 50% 4% 4% Vacancy Rates 19% 4% 0% 12% 50% 12% 4% By country of qualification 15% 8% 8% 12% 50% 4% 4% Absolute change over ten years 15% 12% 0% 8% 50% 12% 4% Percentage change over ten years 12% 8% 4% 8% 50% 12% 8% By gender 23% 4% 12% 12% 46% 4% 0% Absence Rates 15% 12% 8% 8% 46% 8% 4% Percentage change over one year 15% 8% 0% 12% 42% 12% 12% Absolute change over one year 15% 12% 0% 8% 46% 12% 8% Contract Count 15% 8% 12% 8% 42% 15% 0% Average annual percentage change 19% 8% 8% 4% 42% 4% 15% Rows may not sum 100% due to rounding Results: Source: Health and Social Care Information Centre The majority of respondents across all categories were very interested in seeing the categories and statistics that could be included in the publication, with 5 scores Very Interested, receiving 49% of all responses. 1 Score, No interest, received 16% of the responses and 4% did not answer. Summary of comments: 8 comments were received. The comments made by respondents were primarily concerns about the shorter timescales data is now expected and the additional burden to produce more data. When ranked based on the (4 and 5 scores) data, FTE, Headcount and Registered Patients per FTE were the most interesting categories to users. We will aim to preference the most popular categories and statistics within the publication based on the responses received. 20 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Increasing the statistics available for practice staff Q.6: Mirroring the current General Practitioner statistics Given the proposed future change of data source to the new wmds the statistics for practice staff will now be based on individual-level records providing details previously unavailable, such as gender, age and job role. We propose that following the future development and delivery of the wmds, wherever possible and where information collected is of sufficient quality, the statistics and analysis that are currently only available for General Practitioners are replicated for all other professional groups. Question 6.1: Would this additional granularity of statistics for practice-based staff other than General Practitioners be of use to you, based on how you current use the publication or how you could potentially start using it in future? Figure 6a Results: Source: Health and Social Care Information Centre The majority, 69% of respondents, stated that the additional granularity would be of interest. However, it would not be of interest to 19% of respondents and the remaining 12% did not know, either way. Summary of comments: 15 comments were received. It was felt that the additional granularity would be beneficial, but concerns were raised regarding staff identification and also the additional burden of collating the data. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 21

As the majority would find this useful, it will be included in the publication. Nurses and Direct Patient Care staff will be included in the September 2015 publication. Administrative and Other staff will be included in the March 2016 publication. Question 6.2: Are there any other ways that the statistics could be broken down, in addition to those currently provided for General Practitioners (by age, gender etc.), which may be of use to you? Figure 6b Results: Source: Health and Social Care Information Centre The largest number of respondents, 46%, thought there were other useful ways the statistics could be broken down in addition to those already provided within the GP statistics. 31% of respondents thought the opposite, 19% did not know either way and 4% did not answer the question. Summary of comments: 15 comments were received. The majority would be interested in having a similar breakdown to that of GP s, with country of qualification and length of service. 46%, (12) respondents would like to see other useful ways the statistics could be broken down. The HSCIC will implement this proposal. 22 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Changes to the frequency and timing of publication Q.7: Sub-annual publications Given the proposed change of data source to the new wmds the information needed to produce this publication will in the future be available every six months. This will allow, once the wmds has been developed, delivered and initial investigation of the data quality of the wmds data collection has taken place, some form of publication to take place every six months rather than annually. Given the resource requires involved we consider that it would be of limited value to produce a full census publication as is every six months, as such we propose that following the delivery of the wmds we explore the possibility of introducing a smaller secondary publication, relating to the workforce position as of the end of March of that year. Question 7.1: Would another smaller publication midway through the year be of use to you, based on how you currently use the publication or how you could potentially start using it in future? Figure 7a Results: Source: Health and Social Care Information Centre Of the people who responded, there were an equal number of No and Yes replies submitted, with 42% of each. 12% of respondents did not know whether a smaller publication midway through the year, would be of use to them and 4% did not answer the question. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 23

Summary of comments: 12 comments were received. As you would expect from the above split in responses, the comments made in response to this question were also split. Some felt it would be an additional burden on practices and others thought the additional information would help understand trends better. The majority of respondents who did not see a mid-year publication as useful to them cited the reason for this as the increased burden on practices, from moving to a six-month collection cycle. The burden has been assessed by BAAS and has been approved. An online system has been built to help reduce the burden of data collection and will be easier than the previous manual collection method. Further information relating to the burden of the collection, can be found at; www.hscic.gov.uk/baas Question 7.2: What part of the main publication, either within the main publication bulletin or the associated tables and datasets, would you be interested in seeing included in any mid-year publication? Table 7a No Interest Very Interested 1 2 3 4 5 Don't know Not Answered Practice Level Dataset 23% 4% 4% 15% 50% 0% 4% Anonymised GP Level Dataset 15% 4% 12% 12% 50% 8% 0% Bulletin - Summary and Commentary 19% 4% 19% 15% 38% 0% 4% Detailed Tables 31% 4% 8% 15% 35% 4% 4% Bulletin - Tables 27% 4% 15% 12% 38% 4% 0% Bulletin - Analysis and Visualisation 23% 8% 19% 8% 31% 4% 8% Rows may not sum 100% due to rounding Source: Health and Social Care Information Centre Results: The majority, 40%, were very interested in seeing the items listed included within any mid-year publication (based on 5 scores). 6% of respondents either did not know or did not answer the question and 23% had no interest in seeing the items included in a mid-year publication (based on 1 scores). The item that most respondents would be interested in seeing is the Practice Level Dataset. Summary of comments: 1 comment was received. The responder thought it would be useful to receive vacancy information bi-annually. 24 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Practice Level Dataset and Anonymised GP Level Dataset will be included in the mid-year publication as these were the highest ranked (4 and 5 scores). We will aim to work through the others in order of popularity. Question 7.3: Additional more detailed analysis could be included within the mid-year publication based on specific themes of interest at the time of the particular publication. Potential themes could include, for example, a focus on the change in gender representation within GP workforce, or an analysis of the demographics those leaving the GP workforce population. Would such thematic analysis be of use to you? Figure 7b Results: Source: Health and Social Care Information Centre The majority, 42% of respondents did not feel that such thematic analysis would be of use. 35% thought it would benefit them and 23% of respondents did not know either way. Summary of comments: 13 comments were received. The majority of comments made following this question were positive and focussed around time series and trend data being useful, in particular data on joiners and leavers (reasons for leaving, intensions to leave and analysis of the demographics of people entering and leaving the workforce). Copyright 2015, Health and Social Care Information Centre. All rights reserved. 25

The Yes and No results were similar. We feel based on these results and comments there are still some stakeholders who would benefit from this analysis. Therefore, we will aim to include it in future publications where possible, but it will be given a lower priority than other elements. Q.8: Timing of publications The current publication is published approximately six months following the date that the statistics relate to. This is to some extent due to the requirements of the manual submission of General Practitioners not recorded on the NHAIS/ Exeter General Practice Payments System and the practice staff census. Given the future change in data source it may be possible to reduce the time required to publish, making the publication timelier than is currently possible. We propose that following the development and delivery of the wmds we explore opportunities to improve the timeliness of this publication. Results: This question does not have results. Comments were requested. Summary of comments: 13 comments were received. The main theme was the benefit of more timely data, the quicker and more relevant the better. Another key topic raised was the burden on practices and the requests to keep practice involvement to a minimum. Following the comments and in line with the Code of Practice, we will aim to publish the data in a timelier manner. Information from the 31 March 2015 collection will be published during September 2015. Following this we will explore opportunities to reduce the time between collection and publication. 26 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Presenting the statistics Q.9: Enhancements to the clarity, usability and relevance Question 9.1: The publication currently includes summary statistics, interpretation of these statistics, and where possible the raw data that is used to create these statistics in an anonymised form. How useful are these current elements of the publication to you? If you do not currently use the publication please respond with an idea of how useful these may be to you in future. Table 9a Rows may not sum 100% due to rounding Results: Not Useful Very Useful 1 2 3 4 5 Don t know Summary Statistics 8% 4% 23% 23% 31% 12% Interpretation of Statistics 12% 12% 15% 15% 31% 15% Raw Data 27% 8% 8% 8% 38% 12% Source: Health and Social Care Information Centre 33% of respondents thought the current elements of the publication were Very Useful, (based on the 5 scores). 13% did not know how useful the current elements of the publication were. More respondents felt the Summary Statistics category was the most useful of the three categories, within the current publication and received the most responses, (based on 4 and 5 scores). Summary of comments: 8 comments were received. The majority were interested in raw data, as it is easier to use and to interpret. When we rank the (4 and 5 scores) data, all three are high and similar. As a result we will continue to include a mixture of all elements for different stakeholders. There is clearly a need and desire for the analysis of raw data. However, we also recognise that there may be less resource available in General Practices to complete analysis using this raw data. As such, we will look to include summary analysis and simple analytical tools so that practices can benefit directly from this publication. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 27

Question 9.2: Which of the below categorisations would you be interested in seeing the statistics broken down by, based on your current or anticipated requirements? Table 9b No Interest Very Interested 1 2 3 4 5 Don't know Not Answered Working Hours (full/part time etc.) 19% 8% 0% 8% 62% 0% 4% Age Band 12% 4% 12% 12% 58% 0% 4% Practitioner Type / Job Role 12% 4% 12% 19% 50% 0% 4% Length Of Service 19% 4% 8% 15% 50% 0% 4% Contract Type (fixed term, temp etc.) 15% 8% 8% 19% 42% 0% 8% Gender 19% 12% 8% 8% 50% 0% 4% Absence Rate 19% 12% 4% 19% 35% 4% 8% Country of Qualification 15% 19% 8% 12% 42% 0% 4% Destination On Leaving 31% 8% 4% 12% 42% 0% 4% Clinical Sub-Specialty 23% 8% 8% 19% 31% 0% 12% Ethnicity 23% 23% 4% 12% 35% 0% 4% Absence Category 23% 12% 8% 12% 35% 4% 8% Recruitment Source 42% 8% 0% 12% 31% 4% 4% Source: Health and Social Care Information Centre Rows may not sum 100% due to rounding Results: The majority of respondents would be very interested in seeing the statistics broken, down across most categories (based on 5 scores). The one that bucks this trend is the response to the Recruitment Source, where the majority had no interest (based on 1 scores). The possible categories that respondents would be most interested in seeing the statistics broken down by are, Working Hours (full/part time etc.), Age Band and Practitioner Type / Job Role, (based on 4 and 5 scores ranking). Summary of comments: 5 comments were received. A respondent asked for a tool to assist with manipulating the data and others requested information on trainees and clearer defined terms for contractor types. Based on the (4 and 5 scores) data, we will start with the most popular, work through and publish what we can and other categorisations will be made available on request. Age Band, Practitioner Type/Job Role and Working Hours (full/part time etc.), were ranked highest. 28 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Question 9.3: Would you be interested in using interactive tools that allow you to create bespoke visualisations and summaries, if these could be included in the publication? Figure 9a Results: Source: Health and Social Care Information Centre 8% of respondents did not know whether they would be interested in using interactive tools to create bespoke visualisations and summaries. The other 24 respondents were split 50/50, on whether they would be interested or not. Summary of comments: 5 comments were received. They would welcome the facility to create bespoke visualisation and summaries, providing they were easy to use. The Yes and No responses were equal. We will make HSCIC tools available to aid analysis and will announce when these are available. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 29

Question 9.4: In addition to bar charts and line graphs, are there any alternative visualisations that you would be interested in seeing in our publications? These could be either in the publication bulletin, or in any potential interactive tools. Figure 9b Results: Source: Health and Social Care Information Centre The majority, 50% of respondents would not be interested in seeing alternative visualisations in the publications. 8% would like to see alternative visualisations, 23% of respondents did not know either way and 19% did not answer the question. Summary of comments: 5 comments were received: The comments were varied, but the consensus was that raw data was the most useful format to show data. That allows people to adapt the visualisations to suit their needs. As 50% of respondents opted for No, we are not going to add any alternative visualisations into the publication. The publication will remain simple and limited to what is needed. 30 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Question 9.5: The current publication includes two data files showing some anonymised individual level statistics and aggregated practice level statistics. How useful are these data files to you in their current format? If you do not currently use the publication please respond with an idea of how useful these may be to you in future. Table 9c Not Useful Very Useful 1 2 3 4 5 Don't know Practice Level 12% 8% 8% 19% 35% 19% Individual Level 15% 8% 12% 12% 35% 19% Rows may not sum 100% due to rounding Results: Source: Health and Social Care Information Centre 19% of respondents did not know how useful the data files are in their current format. Of the two options, the Practice Level data was considered slightly more useful than Individual Level data, (based on 4 and 5 scores). But, as you can see from the figures it was very close between the two. Summary of comments: 5 comments were received. Respondents were concerned about practice level data becoming identifiable and the data that would be useful to show are staff intension to leave and working hours definitions. Given how useful both data files were considered, they will continue to be included in the publication and development of them will be a priority. New categorisations will be included based on respondents preferences. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 31

Question 9.6 Which of the below categorisations would you be interested in seeing included in these individual and practice level data files, based on your current or anticipated requirements? Table 9d No Interest Very Interested 1 2 3 4 5 Don't know Not Answered Working Hours (full/part time etc.) 15% 8% 4% 12% 54% 4% 4% Length of Service 19% 4% 4% 19% 46% 4% 4% Practitioner Type / Job Role 15% 12% 8% 8% 46% 4% 8% Contract Type (fixed term, temp etc.) 19% 4% 12% 4% 50% 4% 8% Age Band 15% 4% 8% 4% 50% 4% 15% Country of Qualification 31% 8% 0% 15% 38% 4% 4% Destination On Leaving 23% 12% 4% 15% 38% 4% 4% Gender 27% 8% 4% 4% 46% 8% 4% Absence Rate 23% 8% 8% 12% 35% 8% 8% Absence Category 27% 4% 8% 12% 35% 8% 8% Clinical Sub-Specialty 15% 15% 15% 4% 42% 4% 4% Ethnicity 31% 15% 4% 4% 38% 4% 4% Recruitment Source 31% 15% 4% 0% 35% 8% 8% Rows may not sum 100% due to rounding Source: Health and Social Care Information Centre Results: The majority of respondents, 42%, were very interested to see the categories listed included in the individual and practice level data files, (based on 5 scores). This compares to 22%, who had no interest in seeing these, (based in 1 scores). 5% respondents did not know either way whether they would be interested and 6% did not answer. The categories which would interest most respondents are; Working Hours (full/part time etc.) and Length of Service. Respondents were least interested in, Recruitment Source. Summary of comments: 6 comments were received. 1 respondent asked for a tool to assist with manipulating data and others requested information on trainees and clearer defined terms for contractor types. We intend to work through this list in order of priority and attempt to include as many as possible in the publication. Other categorisations will be made available on request. 32 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Further comments Respondents were asked to note down any other comments, ideas or feedback they would like us to consider as part of this consultation. In addition, they were able to submit any further comments to us separately. 10 comments were received. We received some interesting points, the main ones were; It would be helpful if Practices could forecast their needs (3 5 years ahead). This would enable us to try to be pro-active rather than re-active, based on local knowledge, new housing estates, new transport links or closing schools etc. Raw data enables users to create data tables that are useful and relevant and being able to view such data in an iview or NASCIS, or similar system would help. Further data on the other 3 nations would be advantageous for comparability purposes. Data for locum GP s, needs to be collected and broken down the same as other GP s within the publication. Other comments were received regarding the availability of information on Mental Health competency by practice. On the whole respondents were interested in seeing addition elements adding or expanded within the publication. This is providing that the burden on practices isn t increased as a result. All comments will be considered in the future development of this publication and any associated collections. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 33

Executive Summary The workforce Minimum Dataset (wmds) within general and personal medical services has been developed in order to produce a clearer picture of the current and future workforce needs of general practice, to enable service commissioners, providers and others to conduct their workforce planning duties effectively, and to provide information to better inform the public of the current position and changes in the workforce funded through their taxes. This report provides comparative statistics of GPs in England along with information on their practices, staff, patients, and the services they provide. This can be used by service providers to better understand how the make up of their workforce is compared to other organisations, and by service and education commissioners to understand current trends that could influence future commissioning needs. This report shows a snapshot of the general practice workforce as of 31 st September 2015, along with comparative statistics over the last ten years. Key Facts As of 30 th September 2015 there were: 7,812 general practices in England, 13 less than in 2014 and 298 less than in 2005. Including GP Registrars (trainees), 38,256 full time equivalent (FTE) GPs working in these practices, 104 (0.2%) more than the previous year and 3,442 (9.9%) more than in 2005. Excluding GP Registrars (trainees) 33,104 FTE GPs, an increase of 71 (0.2%) in the last year and 1,924 (6.2%) more than in 2005. 15,207 FTE Nurses working in these practices, 117 (0.8%) more than in 2014. Of these, 4,007 FTE where Advanced Level Nurses, and increase of 511 (14.6%) across the same period. 117,102 FTE other staff working in general practice, an increase of 1,897 (1.6%) over the last year. This includes 7,145 FTE Health Care Assistants (HCAs), 6,901 FTE Practice Managers, and 31,189 FTE Receptionists. 36 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Response to the consultation on changes to the General and Personal Medical Services, England General Practitioners Practitioners by Type As of 31 March 2015 there were 38,256 FTE GPs working in general practice in England. Of this, 23,218 FTE were GP Providers, 10,482 FTE were GP Others (mainly salaried GPs), 4,511 FTE were GP Registrars (trainees), and 99 FTE were GP Retainers. Fig 1: FTE GPs by Practitioner Type, 2005-2015 30 September 2015 2005-2015 Provider GP Other 10,482 23,218 30,000 25,000 20,000 15,000 Provider Registrar 4,511 10,000 5,000 GP Other Registrar Retainer 99 0 Retainer There has been a 3.8% increase in FTE GPs since 2014 and a 17.4% increase since 2005 (which equates to an average annual increase across these years of 1.8%). The long term trend for GPs to work in practice for a salary rather than as a partner has continued with a fall in FTE GP Providers of 2.3% (compared to an average annual decrease of 1.4% since 2005) and a rise in GP Others - typically salaried GPs - of 18.2% (compared to an average annual increase of 14.9%). However, there are still more GP Providers than any other category, with GP Providers accounting for 60.6% of the FTE GP workforce in 2015. This has fallen from 83.5% since 2005. Fig 2: Percentage change in FTE GPs by Practitioner Type, 2005-2015 2014-2015 Average Annual Change 2005-2015 Provider -2.3-1.4 GP Other +18.2 +14.9 Registrar +8.0 +6.4 Retainer -14.9-7.6 Copyright 2015, Health and Social Care Information Centre. All rights reserved. 37

Age Response to the consultation on changes to the General and Personal Medical Services, England Practice Manager Age The role of Practice Manager is key within general practice and ensuring there are sufficient people with the skills and experience to do this is an important part of making sure that the future working of general practice is secure. England has 6,901 FTE Practice Managers, of which 1,511 (21.9%) are over the age of 55 and 883 (12.8%) which are under the age of 35. Fig 9: FTE Practice Managers by Gender and Age as at 30 September 2015 Female Male 71 69 67 65 63 61 59 57 55 53 51 49 47 45 43 41 39 37 35 33 31 29 27 200 150 100 50 0 50 100 150 200 Headcount Regionally, Kent and Medway Area Team has the highest proportion of Practice Managers aged 55 and over (29.9%) followed by Essex (28.7%) and then London (27.0%). Cheshire, Warrington and Wirral Area Team has the lowest proportion aged 55 and over at 16.1%. Greater Manchester Area Team has the highest proportion of practitioners under 35 with 17.5%, with the Kent and Medway Area Team having the lowest proportion at 7.6%. 38 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

Working Time Commitment The number of hours worked by each member of staff is an important consideration when planning the education and training needs of a service as, for example, the amount of training that needs to be commissioned may be greater for a service that has two nurses working 10 hours a week than for another service that has one nurse working 20 hours a week. As with elsewhere in this publication all figures in this section express working hours as a proportion of a full time equivalent (FTE) working week. Nurses England has 24,138 Headcount Nurses working between them a FTE of 15,207. 14.3% of Nurses are contracted to work 1 FTE or more with 35.7% contracted to work less than 0.5 FTE. Fig 13: Working Time Commitment, Nurses, as at 30 September 2015 All Nurses Advanced Level Nurses Other Nurses Under 0.25 FTE 0.25 to <0.5 FTE 0.5 to <0.75 FTE 0.75 to <1.0 FTE 1 FTE and over 0% 10% 20% 30% 40% 0% 10% 20% 30% 40% 0% 10% 20% 30% 40% Headcount 24,138 5,415 18,723 Direct Patient Care England has 17,128 Headcount Direct Patient Care workers working between them a FTE of 9,601. 11.2% of Direct Patient Care workers are contracted to work 1 FTE or more with 49.1% contracted to work less than 0.5 FTE. Fig 14: Working Time Commitment, Direct Patient Care, as at 30 September 2015 All Direct Patient Care Health Care Assistants Other Direct Patient Care Under 0.25 FTE 0.25 to <0.5 FTE 0.5 to <0.75 FTE 0.75 to <1.0 FTE 1 FTE and over 0% 10% 20% 30% 40% 0% 10% 20% 30% 40% 0% 10% 20% 30% 40% Headcount 17,128 12,759 4,369 40 Copyright 2015, Health and Social Care Information Centre. All rights reserved.