Journal of the Royal Statistical Society, May 30, 2023
We now stand at the cusp of an exciting era in the development of economic statistics. Our method... more We now stand at the cusp of an exciting era in the development of economic statistics. Our methods are becoming increasingly sophisticated and granular, better reflecting the changing nature of our society and economy. As we continue to push the boundaries of statistical analysis, we inch closer to meeting Robert Kennedy's challenge of 18 March 1968-to measure not only the output of our economy but also the well-being of our citizens and the quality of our environment. From the 1950s to the 1990s, economic statistics underwent significant transformation. The expansion of Gross Domestic Product (GDP) measurements, statistics of the construction industry, balance of payments, and public sector expenditure metrics mirrored the rapid progress of postwar Britain. Advances in computer technology during the 1980s facilitated more efficient data processing, while the 1990s witnessed the creation of the first environmental accounts and the introduction of the Consumer Prices Index (CPI). However, the turn of the millennium saw a deceleration in the evolution of economic statistics. The Bean Review in 2016 exposed the widening gap between the opportunities for economic statistics and the Office for National Statistics' (ONS) capacity to seize them. This underscored the need to rekindle the pioneering spirit of earlier decades and establish a new era for economic statistics in the UK. A dynamic economy requires a dynamic statistical office. The Bean Review set the stage for modernisation, fostering administrative and commercial big data, data science, and collaboration with academia. As the pandemic unfolded, it served as a catalyst for innovation, similar to how wartime needs had driven the development of economic statistics in the past. During the pandemic, the ONS played a critical role in providing timely data to support informed decision-making. New data sources and online business and household surveys were rapidly implemented, allowing for real-time tracking of the pandemic's impact. The ONS also expanded its scope, releasing the widely acclaimed Covid Infection Survey. As the pandemic subsides, there is a clear demand for retaining these newly developed methods and data sources due to their ongoing value. The lessons learned from the pandemic have set the stage for a new era of economic statistics, marked by innovation, adaptability, and resilience. It allows us to try and broaden out our understanding of our economy and society. Developments in data science provide us with the tools to make the most of this new era. We were able to harness real-time card transactions data during the pandemic to observe the effect of lockdowns. Now we can use the same tools to see how unexpected events such as additional Bank Holidays can affect GDP. We are investing heavily in scanner data to give us much more granular information on the prices actually paid at the shops, and have just introduced real-time rail fares transaction data into the CPI. Later in 2023, we will also be consulting on the transformation of our population statistics, where new data science techniques can allow us drive new value out of administrative data. We are also looking Beyond GDP. We want to be able to capture better environmental and social progress, in addition to our strengths in economic data. The ONS has an exciting programme of work looking at 'the missing capitals'-intangible capital (brands, intellectual property,
Background UK general practice faces a workforce crisis, with general practitioner (GP) shortages... more Background UK general practice faces a workforce crisis, with general practitioner (GP) shortages, organisational change, substantial pressures across the whole health-care system and an ageing population with increasingly complex health needs. GPs require lengthy training, so retaining the existing workforce is urgent and important. Objectives (1) To identify the key policies and strategies that might (i) facilitate the retention of experienced GPs in direct patient care or (ii) support the return of GPs following a career break. (2) To consider the feasibility of potentially implementing those policies and strategies. Design This was a comprehensive, mixed-methods study. Setting This study took place in primary care in England. Participants General practitioners registered in south-west England were surveyed. Interviews were with purposively selected GPs and primary care stakeholders. A RAND/UCLA Appropriateness Method (RAM) panel comprised GP partners and GPs working in national ...
Employment Relations Research Series No. 63 DTI’s Fair Treatment at Work Survey 2005 is Britain’s... more Employment Relations Research Series No. 63 DTI’s Fair Treatment at Work Survey 2005 is Britain’s first large-scale official survey of unfair treatment, perceived discrimination, bullying and sexual harassment in the workplace. The survey involved face-to-face interviews with 3,936 employees across Great Britain, between November 2005 and January 2006. Personal experience of unfair treatment at work The survey found a relatively low incidence of unfair treatment at work. In total, around 1.7 million or 6.9 per cent of employees said they had personally been treated unfairly at work in the last two years. There were relatively small differences in the rate of unfair treatment experienced by sex, religion or sector. Those with a disability or long-term illness, however, were twice as likely as other employees to have experienced unfair treatment at work. This was also the case for gay, lesbian or bisexual employees. More black employees (12.5 per cent) experienced unfair treatment at work than did Asians (8 per cent) or whites (6.5 per cent). Older employees, aged 45 or more, were less likely to report unfair treatment at work than those aged less than 45 years. Of the individual reasons cited by employees for their unfair treatment, the most common was age, followed by long-term illness (both reported by 0.8 per cent of all employees). The third was ‘accent or the way I speak’ (0.5 per cent), followed by race and ethnic group, disability, ‘physical appearance’, gender, ‘being pregnant’, nationality, and ‘the way I dress’ (all 0.4 per cent). Union membership, religion and ‘colour of skin’ were each reported by 0.3 per cent of employees. Discrimination at work Seven in every ten employees who had been treated unfairly at work in the last two years considered this to be discrimination. If we confine those responses to the six equality strands covered or soon to be covered by UK law (sex, race, disability, religion, sexual orientation and age), 3.5 per cent of all employees said they had experienced discrimination at work in the last two years. Some types of employees were more likely to have experienced discrimination at work: disabled employees (9.0 per cent), gay, lesbian or bisexual employees (8.1 per cent), black employees (7.3 per cent), foreign-born employees (6.4 per cent), Muslim employees (5.7 per cent), and Asian employees (5.5 per cent). Of the six equality strands, discrimination at work relating to disability and long-term illness was the most common, covering 1.2 per cent of all employees. This was followed by gender (0.9 per cent), race-related discrimination (0.8 per cent), age (0.8 per cent) and religion (0.2 per cent). Sexual orientation was lowest - however the figure was too small to be reported. Advice or information sought Over half of employees who had been unfairly treated sought advice or information about their problem. Women were more likely than men to seek advice, and trade union members more likely than non-unionists. Private sector and foreign-born employees were less likely to seek advice than the public sector and UK born employees. Two-fifths of employees who sought advice said they contacted their line manager or supervisor, or a trade union or trade union officer. Trade unions provided the most helpful advice (30 per cent). Steps taken to deal with the situation While one in six employees (16 per cent) who had been unfairly treated did nothing about their situation, one-third raised the issue with their employer and four-fifths said that they dealt with it in some way. One in twelve (8 per cent) resigned, and 4 per cent were dismissed or made redundant. Men were more likely than women to do nothing (20 per cent vs. 13 per cent). Women were more likely than men to leave the organisation (18 per cent vs. 10 per cent). Unfair treatment experienced by other employees Eighty-five percent of all employees neither experienced unfair treatment themselves, nor were aware of any other person at their workplace being treated unfairly. One in seven (14.0%) employees who worked with others said that they were aware of another person at their place of work being treated unfairly in the last two years. Of those employees who worked with others, disabled employees (21 per cent), gay, lesbian or bisexual employees (18 per cent), black employees (17 per cent) and public sector employees (17 per cent) were more likely to report unfair treatment of others at their workplace. By far the most common reason given for unfair treatment of others was long term illness, cited by 3.8 per cent of employees who worked with others. This was followed by age and ‘the way they dress’ (both 1.9 per cent), and race or ethnic group (1.6 per cent). The incidence of unfair treatment of others due to gender (1.2 per cent), religion (1.0 per cent) and sexual orientation (1.0 per cent) were lower. Workplace bullying The incidence of bullying in British workplaces is quite high – almost one million employees (3.8 per…
An analysis of trends over the past decade in earnings, job growth, employment security and worki... more An analysis of trends over the past decade in earnings, job growth, employment security and working time experienced by UK employees.
The complexity of employment arrangements in various countries tends to make it difficult to unde... more The complexity of employment arrangements in various countries tends to make it difficult to understand them. Nevertheless, it is important to 'take stock' periodically, particularly from an internationally comparative perspective. This remarkable book is a giant step in that direction. It is especially valuable in the context of increasing globalisation. For each of nine key jurisdictions - the European Union, Germany, Sweden, United Kingdom, United States of America, Canada, New Zealand, Australia, and Japan -experts present detailed information and analysis on key issues, shedding valuable light on trends in such specific areas of employment relations as the following: * atypical work and flexible work arrangements; * dispute settlement procedures such as negotiation, conciliation, mediation, arbitration and other forms of governmental or judicial intervention; * job security, anti-discrimination, and gender equality; * recognition of unions and employers' association...
... Recent UK trends GRANT FITZNER, EMPLOYMENT MARKET ANALYSIS AND RESEARCH Department of Trade a... more ... Recent UK trends GRANT FITZNER, EMPLOYMENT MARKET ANALYSIS AND RESEARCH Department of Trade and Industry ... Grant Fitzner Director, Employment Market Analysis and Research Department of Trade and Industry 3 How have employees fared? Page 6. ...
Background
UK general practice faces a workforce crisis, with general practitioner (GP) shortages... more Background UK general practice faces a workforce crisis, with general practitioner (GP) shortages, organisational change, substantial pressures across the whole health-care system and an ageing population with increasingly complex health needs. GPs require lengthy training, so retaining the existing workforce is urgent and important.
Objectives (1) To identify the key policies and strategies that might (i) facilitate the retention of experienced GPs in direct patient care or (ii) support the return of GPs following a career break. (2) To consider the feasibility of potentially implementing those policies and strategies.
Design This was a comprehensive, mixed-methods study.
Setting This study took place in primary care in England.
Participants General practitioners registered in south-west England were surveyed. Interviews were with purposively selected GPs and primary care stakeholders. A RAND/UCLA Appropriateness Method (RAM) panel comprised GP partners and GPs working in national stakeholder organisations. Stakeholder consultations included representatives from regional and national groups.
Main outcome measures Systematic review – factors affecting GPs’ decisions to quit and to take career breaks. Survey – proportion of GPs likely to quit, to take career breaks or to reduce hours spent in patient care within 5 years of being surveyed. Interviews – themes relating to GPs’ decision-making. RAM – a set of policies and strategies to support retention, assessed as ‘appropriate’ and ‘feasible’. Predictive risk modelling – predictive model to identify practices in south-west England at risk of workforce undersupply within 5 years. Stakeholder consultation – comments and key actions regarding implementing emergent policies and strategies from the research.
Results Past research identified four job-related ‘push’ factors associated with leaving general practice: (1) workload, (2) job dissatisfaction, (3) work-related stress and (4) work–life balance. The survey, returned by 2248 out of 3370 GPs (67%) in the south-west of England, identified a high likelihood of quitting (37%), taking a career break (36%) or reducing hours (57%) within 5 years. Interviews highlighted three drivers of leaving general practice: (1) professional identity and value of the GP role, (2) fear and risk associated with service delivery and (3) career choices. The RAM panel deemed 24 out of 54 retention policies and strategies to be ‘appropriate’, with most also considered ‘feasible’, including identification of and targeted support for practices ‘at risk’ of workforce undersupply and the provision of formal career options for GPs wishing to undertake portfolio roles. Practices at highest risk of workforce undersupply within 5 years are those that have larger patient list sizes, employ more nurses, serve more deprived and younger populations, or have poor patient experience ratings. Actions for national organisations with an interest in workforce planning were identified. These included collection of data on the current scope of GPs’ portfolio roles, and the need for formal career pathways for key primary care professionals, such as practice managers.
Limitations The survey, qualitative research and modelling were conducted in one UK region. The research took place within a rapidly changing policy environment, providing a challenge in informing emergent policy and practice.
Conclusions This research identifies the basis for current concerns regarding UK GP workforce capacity, drawing on experiences in south-west England. Policies and strategies identified by expert stakeholders after considering these findings are likely to be of relevance in addressing GP retention in the UK. Collaborative, multidisciplinary research partnerships should investigate the effects of rolling out some of the policies and strategies described in this report.
Study registration This study is registered as PROSPERO CRD42016033876 and UKCRN ID number 20700.
Funding The National Institute for Health Research Health Services and Delivery Research programme.
Long-term NHS expenditure trends and affordability constraints, Jul 2015
This technical paper addresses the constraints on government healthcare expenditure and affordabi... more This technical paper addresses the constraints on government healthcare expenditure and affordability options facing the NHS over the period to 2035, drawing on long-term historical data.
The Centre for Workforce Intelligence (CfWI) have had a long-standing interest in the affordability of options for the healthcare workforce planning. This is ultimately determined by the level of NHS funding available, along with the remuneration and efficiency of the workforce.
In this paper we analyse long-term trends in government healthcare expenditure in the United Kingdom, measured as a proportion of GDP, share of government spending and in real per capita basis.
Preliminary findings highlighted in the report include:
* Like other OECD countries, government healthcare expenditure in the UK has increased markedly since the 1950s in real per capita terms and as a share of total government spending.
* Barring a major crisis, this secular trend is likely to continue in the decades ahead, albeit possibly at a slower pace than in recent decades.
* However, trends over the last 64 years show there are plausible constraints for future healthcare spending which set effective ceilings and floors to future trends in healthcare spending.
* Within those global parameters, large and sustained increases in real healthcare spending per capita can be expected to pose significant affordability challenges for government.
* Conversely, falls in real per capita government healthcare spending are unlikely to be sustainable for a prolonged period. History shows prolonged declines to be rare.
* In recent years we have moved from a period of above-median growth in real per capita government healthcare spending to a period of below-median growth. The current period may come to be seen as an important inflection point for healthcare spending. However, ultimately we expect to see regression to the median in healthcare spending.
The paper also identifies several potential areas for further research.
In-depth review of the general practitioner workforce: Final report, Jul 2014
The Centre for Workforce Intelligence (CfWI) was commissioned by the Department of Health (DH) an... more The Centre for Workforce Intelligence (CfWI) was commissioned by the Department of Health (DH) and Health Education England (HEE) to conduct an in-depth review of the general practitioner (GP) workforce in England.
This is a medium-term strategic review looking ahead to 2030, designed to provide the evidence base for forecasting workforce demand and supply, to enable sustainable improvements in planning for the GP workforce of the future.
The focus of this review is on GPs who have completed their Certificate of Completion of Training (CCT holders). The CfWI concludes that the current level of GPs being trained is inadequate and likely to lead to a major workforce demand-supply imbalance by 2020 unless action is taken. The CfWI suggests HEE consider a substantial increase in GP training numbers plus a number of measures to help boost workforce supply, particularly in the short term, given the significant lead-in time in training new GPs.
The CfWI worked with the General Practice Task Force on this review.
GP in-depth review: Preliminary findings, Mar 2013
The Centre for Workforce Intelligence (CfWI) was commissioned by the Department of Health (DH) an... more The Centre for Workforce Intelligence (CfWI) was commissioned by the Department of Health (DH) and Health Education England (HEE) to undertake an in-depth review of the GP workforce in England. This is a medium-term, strategic review looking ahead to 2030.
This report presents our preliminary findings for consultation purposes. Please note that as some data and assumptions will be updated for our final forecasts, the analysis and conclusions in our final report may differ from those presented in this report.
Emerging recommendations
We reaffirm our previous recommendation (CfWI, 2011a) that there needs to be a substantial increase in GP training phased in over several years. We consider that achieving and maintaining 3,250 GP trainees per annum is necessary to address future demand, and should be the top priority. A substantial share of this workforce increase should go towards improving support for under-doctored areas to help achieve more equal access to GP services across England.
Given the rapidly changing nature of healthcare and the inherent uncertainties about future demand, however, we also recommend there be periodic reviews of future GP workforce supply and demand every 3–5 years, supported by a stronger evidence base.
Action is also needed to improve the attractiveness of general practice as a career, including promotion among medical students (and possibly earlier). We see merit in seeking to retain the existing workforce, for example ‘retainer schemes’ – particularly in areas where GPs are under most pressure – and providing support for returners through return-to-practice schemes. The GP Task Force is reviewing these areas.
Note: The final GP report was published by CfWI in July 2014 and can be found at: www.cfwi.org.uk
Journal of the Royal Statistical Society, May 30, 2023
We now stand at the cusp of an exciting era in the development of economic statistics. Our method... more We now stand at the cusp of an exciting era in the development of economic statistics. Our methods are becoming increasingly sophisticated and granular, better reflecting the changing nature of our society and economy. As we continue to push the boundaries of statistical analysis, we inch closer to meeting Robert Kennedy's challenge of 18 March 1968-to measure not only the output of our economy but also the well-being of our citizens and the quality of our environment. From the 1950s to the 1990s, economic statistics underwent significant transformation. The expansion of Gross Domestic Product (GDP) measurements, statistics of the construction industry, balance of payments, and public sector expenditure metrics mirrored the rapid progress of postwar Britain. Advances in computer technology during the 1980s facilitated more efficient data processing, while the 1990s witnessed the creation of the first environmental accounts and the introduction of the Consumer Prices Index (CPI). However, the turn of the millennium saw a deceleration in the evolution of economic statistics. The Bean Review in 2016 exposed the widening gap between the opportunities for economic statistics and the Office for National Statistics' (ONS) capacity to seize them. This underscored the need to rekindle the pioneering spirit of earlier decades and establish a new era for economic statistics in the UK. A dynamic economy requires a dynamic statistical office. The Bean Review set the stage for modernisation, fostering administrative and commercial big data, data science, and collaboration with academia. As the pandemic unfolded, it served as a catalyst for innovation, similar to how wartime needs had driven the development of economic statistics in the past. During the pandemic, the ONS played a critical role in providing timely data to support informed decision-making. New data sources and online business and household surveys were rapidly implemented, allowing for real-time tracking of the pandemic's impact. The ONS also expanded its scope, releasing the widely acclaimed Covid Infection Survey. As the pandemic subsides, there is a clear demand for retaining these newly developed methods and data sources due to their ongoing value. The lessons learned from the pandemic have set the stage for a new era of economic statistics, marked by innovation, adaptability, and resilience. It allows us to try and broaden out our understanding of our economy and society. Developments in data science provide us with the tools to make the most of this new era. We were able to harness real-time card transactions data during the pandemic to observe the effect of lockdowns. Now we can use the same tools to see how unexpected events such as additional Bank Holidays can affect GDP. We are investing heavily in scanner data to give us much more granular information on the prices actually paid at the shops, and have just introduced real-time rail fares transaction data into the CPI. Later in 2023, we will also be consulting on the transformation of our population statistics, where new data science techniques can allow us drive new value out of administrative data. We are also looking Beyond GDP. We want to be able to capture better environmental and social progress, in addition to our strengths in economic data. The ONS has an exciting programme of work looking at 'the missing capitals'-intangible capital (brands, intellectual property,
Background UK general practice faces a workforce crisis, with general practitioner (GP) shortages... more Background UK general practice faces a workforce crisis, with general practitioner (GP) shortages, organisational change, substantial pressures across the whole health-care system and an ageing population with increasingly complex health needs. GPs require lengthy training, so retaining the existing workforce is urgent and important. Objectives (1) To identify the key policies and strategies that might (i) facilitate the retention of experienced GPs in direct patient care or (ii) support the return of GPs following a career break. (2) To consider the feasibility of potentially implementing those policies and strategies. Design This was a comprehensive, mixed-methods study. Setting This study took place in primary care in England. Participants General practitioners registered in south-west England were surveyed. Interviews were with purposively selected GPs and primary care stakeholders. A RAND/UCLA Appropriateness Method (RAM) panel comprised GP partners and GPs working in national ...
Employment Relations Research Series No. 63 DTI’s Fair Treatment at Work Survey 2005 is Britain’s... more Employment Relations Research Series No. 63 DTI’s Fair Treatment at Work Survey 2005 is Britain’s first large-scale official survey of unfair treatment, perceived discrimination, bullying and sexual harassment in the workplace. The survey involved face-to-face interviews with 3,936 employees across Great Britain, between November 2005 and January 2006. Personal experience of unfair treatment at work The survey found a relatively low incidence of unfair treatment at work. In total, around 1.7 million or 6.9 per cent of employees said they had personally been treated unfairly at work in the last two years. There were relatively small differences in the rate of unfair treatment experienced by sex, religion or sector. Those with a disability or long-term illness, however, were twice as likely as other employees to have experienced unfair treatment at work. This was also the case for gay, lesbian or bisexual employees. More black employees (12.5 per cent) experienced unfair treatment at work than did Asians (8 per cent) or whites (6.5 per cent). Older employees, aged 45 or more, were less likely to report unfair treatment at work than those aged less than 45 years. Of the individual reasons cited by employees for their unfair treatment, the most common was age, followed by long-term illness (both reported by 0.8 per cent of all employees). The third was ‘accent or the way I speak’ (0.5 per cent), followed by race and ethnic group, disability, ‘physical appearance’, gender, ‘being pregnant’, nationality, and ‘the way I dress’ (all 0.4 per cent). Union membership, religion and ‘colour of skin’ were each reported by 0.3 per cent of employees. Discrimination at work Seven in every ten employees who had been treated unfairly at work in the last two years considered this to be discrimination. If we confine those responses to the six equality strands covered or soon to be covered by UK law (sex, race, disability, religion, sexual orientation and age), 3.5 per cent of all employees said they had experienced discrimination at work in the last two years. Some types of employees were more likely to have experienced discrimination at work: disabled employees (9.0 per cent), gay, lesbian or bisexual employees (8.1 per cent), black employees (7.3 per cent), foreign-born employees (6.4 per cent), Muslim employees (5.7 per cent), and Asian employees (5.5 per cent). Of the six equality strands, discrimination at work relating to disability and long-term illness was the most common, covering 1.2 per cent of all employees. This was followed by gender (0.9 per cent), race-related discrimination (0.8 per cent), age (0.8 per cent) and religion (0.2 per cent). Sexual orientation was lowest - however the figure was too small to be reported. Advice or information sought Over half of employees who had been unfairly treated sought advice or information about their problem. Women were more likely than men to seek advice, and trade union members more likely than non-unionists. Private sector and foreign-born employees were less likely to seek advice than the public sector and UK born employees. Two-fifths of employees who sought advice said they contacted their line manager or supervisor, or a trade union or trade union officer. Trade unions provided the most helpful advice (30 per cent). Steps taken to deal with the situation While one in six employees (16 per cent) who had been unfairly treated did nothing about their situation, one-third raised the issue with their employer and four-fifths said that they dealt with it in some way. One in twelve (8 per cent) resigned, and 4 per cent were dismissed or made redundant. Men were more likely than women to do nothing (20 per cent vs. 13 per cent). Women were more likely than men to leave the organisation (18 per cent vs. 10 per cent). Unfair treatment experienced by other employees Eighty-five percent of all employees neither experienced unfair treatment themselves, nor were aware of any other person at their workplace being treated unfairly. One in seven (14.0%) employees who worked with others said that they were aware of another person at their place of work being treated unfairly in the last two years. Of those employees who worked with others, disabled employees (21 per cent), gay, lesbian or bisexual employees (18 per cent), black employees (17 per cent) and public sector employees (17 per cent) were more likely to report unfair treatment of others at their workplace. By far the most common reason given for unfair treatment of others was long term illness, cited by 3.8 per cent of employees who worked with others. This was followed by age and ‘the way they dress’ (both 1.9 per cent), and race or ethnic group (1.6 per cent). The incidence of unfair treatment of others due to gender (1.2 per cent), religion (1.0 per cent) and sexual orientation (1.0 per cent) were lower. Workplace bullying The incidence of bullying in British workplaces is quite high – almost one million employees (3.8 per…
An analysis of trends over the past decade in earnings, job growth, employment security and worki... more An analysis of trends over the past decade in earnings, job growth, employment security and working time experienced by UK employees.
The complexity of employment arrangements in various countries tends to make it difficult to unde... more The complexity of employment arrangements in various countries tends to make it difficult to understand them. Nevertheless, it is important to 'take stock' periodically, particularly from an internationally comparative perspective. This remarkable book is a giant step in that direction. It is especially valuable in the context of increasing globalisation. For each of nine key jurisdictions - the European Union, Germany, Sweden, United Kingdom, United States of America, Canada, New Zealand, Australia, and Japan -experts present detailed information and analysis on key issues, shedding valuable light on trends in such specific areas of employment relations as the following: * atypical work and flexible work arrangements; * dispute settlement procedures such as negotiation, conciliation, mediation, arbitration and other forms of governmental or judicial intervention; * job security, anti-discrimination, and gender equality; * recognition of unions and employers' association...
... Recent UK trends GRANT FITZNER, EMPLOYMENT MARKET ANALYSIS AND RESEARCH Department of Trade a... more ... Recent UK trends GRANT FITZNER, EMPLOYMENT MARKET ANALYSIS AND RESEARCH Department of Trade and Industry ... Grant Fitzner Director, Employment Market Analysis and Research Department of Trade and Industry 3 How have employees fared? Page 6. ...
Background
UK general practice faces a workforce crisis, with general practitioner (GP) shortages... more Background UK general practice faces a workforce crisis, with general practitioner (GP) shortages, organisational change, substantial pressures across the whole health-care system and an ageing population with increasingly complex health needs. GPs require lengthy training, so retaining the existing workforce is urgent and important.
Objectives (1) To identify the key policies and strategies that might (i) facilitate the retention of experienced GPs in direct patient care or (ii) support the return of GPs following a career break. (2) To consider the feasibility of potentially implementing those policies and strategies.
Design This was a comprehensive, mixed-methods study.
Setting This study took place in primary care in England.
Participants General practitioners registered in south-west England were surveyed. Interviews were with purposively selected GPs and primary care stakeholders. A RAND/UCLA Appropriateness Method (RAM) panel comprised GP partners and GPs working in national stakeholder organisations. Stakeholder consultations included representatives from regional and national groups.
Main outcome measures Systematic review – factors affecting GPs’ decisions to quit and to take career breaks. Survey – proportion of GPs likely to quit, to take career breaks or to reduce hours spent in patient care within 5 years of being surveyed. Interviews – themes relating to GPs’ decision-making. RAM – a set of policies and strategies to support retention, assessed as ‘appropriate’ and ‘feasible’. Predictive risk modelling – predictive model to identify practices in south-west England at risk of workforce undersupply within 5 years. Stakeholder consultation – comments and key actions regarding implementing emergent policies and strategies from the research.
Results Past research identified four job-related ‘push’ factors associated with leaving general practice: (1) workload, (2) job dissatisfaction, (3) work-related stress and (4) work–life balance. The survey, returned by 2248 out of 3370 GPs (67%) in the south-west of England, identified a high likelihood of quitting (37%), taking a career break (36%) or reducing hours (57%) within 5 years. Interviews highlighted three drivers of leaving general practice: (1) professional identity and value of the GP role, (2) fear and risk associated with service delivery and (3) career choices. The RAM panel deemed 24 out of 54 retention policies and strategies to be ‘appropriate’, with most also considered ‘feasible’, including identification of and targeted support for practices ‘at risk’ of workforce undersupply and the provision of formal career options for GPs wishing to undertake portfolio roles. Practices at highest risk of workforce undersupply within 5 years are those that have larger patient list sizes, employ more nurses, serve more deprived and younger populations, or have poor patient experience ratings. Actions for national organisations with an interest in workforce planning were identified. These included collection of data on the current scope of GPs’ portfolio roles, and the need for formal career pathways for key primary care professionals, such as practice managers.
Limitations The survey, qualitative research and modelling were conducted in one UK region. The research took place within a rapidly changing policy environment, providing a challenge in informing emergent policy and practice.
Conclusions This research identifies the basis for current concerns regarding UK GP workforce capacity, drawing on experiences in south-west England. Policies and strategies identified by expert stakeholders after considering these findings are likely to be of relevance in addressing GP retention in the UK. Collaborative, multidisciplinary research partnerships should investigate the effects of rolling out some of the policies and strategies described in this report.
Study registration This study is registered as PROSPERO CRD42016033876 and UKCRN ID number 20700.
Funding The National Institute for Health Research Health Services and Delivery Research programme.
Long-term NHS expenditure trends and affordability constraints, Jul 2015
This technical paper addresses the constraints on government healthcare expenditure and affordabi... more This technical paper addresses the constraints on government healthcare expenditure and affordability options facing the NHS over the period to 2035, drawing on long-term historical data.
The Centre for Workforce Intelligence (CfWI) have had a long-standing interest in the affordability of options for the healthcare workforce planning. This is ultimately determined by the level of NHS funding available, along with the remuneration and efficiency of the workforce.
In this paper we analyse long-term trends in government healthcare expenditure in the United Kingdom, measured as a proportion of GDP, share of government spending and in real per capita basis.
Preliminary findings highlighted in the report include:
* Like other OECD countries, government healthcare expenditure in the UK has increased markedly since the 1950s in real per capita terms and as a share of total government spending.
* Barring a major crisis, this secular trend is likely to continue in the decades ahead, albeit possibly at a slower pace than in recent decades.
* However, trends over the last 64 years show there are plausible constraints for future healthcare spending which set effective ceilings and floors to future trends in healthcare spending.
* Within those global parameters, large and sustained increases in real healthcare spending per capita can be expected to pose significant affordability challenges for government.
* Conversely, falls in real per capita government healthcare spending are unlikely to be sustainable for a prolonged period. History shows prolonged declines to be rare.
* In recent years we have moved from a period of above-median growth in real per capita government healthcare spending to a period of below-median growth. The current period may come to be seen as an important inflection point for healthcare spending. However, ultimately we expect to see regression to the median in healthcare spending.
The paper also identifies several potential areas for further research.
In-depth review of the general practitioner workforce: Final report, Jul 2014
The Centre for Workforce Intelligence (CfWI) was commissioned by the Department of Health (DH) an... more The Centre for Workforce Intelligence (CfWI) was commissioned by the Department of Health (DH) and Health Education England (HEE) to conduct an in-depth review of the general practitioner (GP) workforce in England.
This is a medium-term strategic review looking ahead to 2030, designed to provide the evidence base for forecasting workforce demand and supply, to enable sustainable improvements in planning for the GP workforce of the future.
The focus of this review is on GPs who have completed their Certificate of Completion of Training (CCT holders). The CfWI concludes that the current level of GPs being trained is inadequate and likely to lead to a major workforce demand-supply imbalance by 2020 unless action is taken. The CfWI suggests HEE consider a substantial increase in GP training numbers plus a number of measures to help boost workforce supply, particularly in the short term, given the significant lead-in time in training new GPs.
The CfWI worked with the General Practice Task Force on this review.
GP in-depth review: Preliminary findings, Mar 2013
The Centre for Workforce Intelligence (CfWI) was commissioned by the Department of Health (DH) an... more The Centre for Workforce Intelligence (CfWI) was commissioned by the Department of Health (DH) and Health Education England (HEE) to undertake an in-depth review of the GP workforce in England. This is a medium-term, strategic review looking ahead to 2030.
This report presents our preliminary findings for consultation purposes. Please note that as some data and assumptions will be updated for our final forecasts, the analysis and conclusions in our final report may differ from those presented in this report.
Emerging recommendations
We reaffirm our previous recommendation (CfWI, 2011a) that there needs to be a substantial increase in GP training phased in over several years. We consider that achieving and maintaining 3,250 GP trainees per annum is necessary to address future demand, and should be the top priority. A substantial share of this workforce increase should go towards improving support for under-doctored areas to help achieve more equal access to GP services across England.
Given the rapidly changing nature of healthcare and the inherent uncertainties about future demand, however, we also recommend there be periodic reviews of future GP workforce supply and demand every 3–5 years, supported by a stronger evidence base.
Action is also needed to improve the attractiveness of general practice as a career, including promotion among medical students (and possibly earlier). We see merit in seeking to retain the existing workforce, for example ‘retainer schemes’ – particularly in areas where GPs are under most pressure – and providing support for returners through return-to-practice schemes. The GP Task Force is reviewing these areas.
Note: The final GP report was published by CfWI in July 2014 and can be found at: www.cfwi.org.uk
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Papers by Grant Fitzner
UK general practice faces a workforce crisis, with general practitioner (GP) shortages, organisational change, substantial pressures across the whole health-care system and an ageing population with increasingly complex health needs. GPs require lengthy training, so retaining the existing workforce is urgent and important.
Objectives
(1) To identify the key policies and strategies that might (i) facilitate the retention of experienced GPs in direct patient care or (ii) support the return of GPs following a career break. (2) To consider the feasibility of potentially implementing those policies and strategies.
Design
This was a comprehensive, mixed-methods study.
Setting
This study took place in primary care in England.
Participants
General practitioners registered in south-west England were surveyed. Interviews were with purposively selected GPs and primary care stakeholders. A RAND/UCLA Appropriateness Method (RAM) panel comprised GP partners and GPs working in national stakeholder organisations. Stakeholder consultations included representatives from regional and national groups.
Main outcome measures
Systematic review – factors affecting GPs’ decisions to quit and to take career breaks. Survey – proportion of GPs likely to quit, to take career breaks or to reduce hours spent in patient care within 5 years of being surveyed. Interviews – themes relating to GPs’ decision-making. RAM – a set of policies and strategies to support retention, assessed as ‘appropriate’ and ‘feasible’. Predictive risk modelling – predictive model to identify practices in south-west England at risk of workforce undersupply within 5 years. Stakeholder consultation – comments and key actions regarding implementing emergent policies and strategies from the research.
Results
Past research identified four job-related ‘push’ factors associated with leaving general practice: (1) workload, (2) job dissatisfaction, (3) work-related stress and (4) work–life balance. The survey, returned by 2248 out of 3370 GPs (67%) in the south-west of England, identified a high likelihood of quitting (37%), taking a career break (36%) or reducing hours (57%) within 5 years. Interviews highlighted three drivers of leaving general practice: (1) professional identity and value of the GP role, (2) fear and risk associated with service delivery and (3) career choices. The RAM panel deemed 24 out of 54 retention policies and strategies to be ‘appropriate’, with most also considered ‘feasible’, including identification of and targeted support for practices ‘at risk’ of workforce undersupply and the provision of formal career options for GPs wishing to undertake portfolio roles. Practices at highest risk of workforce undersupply within 5 years are those that have larger patient list sizes, employ more nurses, serve more deprived and younger populations, or have poor patient experience ratings. Actions for national organisations with an interest in workforce planning were identified. These included collection of data on the current scope of GPs’ portfolio roles, and the need for formal career pathways for key primary care professionals, such as practice managers.
Limitations
The survey, qualitative research and modelling were conducted in one UK region. The research took place within a rapidly changing policy environment, providing a challenge in informing emergent policy and practice.
Conclusions
This research identifies the basis for current concerns regarding UK GP workforce capacity, drawing on experiences in south-west England. Policies and strategies identified by expert stakeholders after considering these findings are likely to be of relevance in addressing GP retention in the UK. Collaborative, multidisciplinary research partnerships should investigate the effects of rolling out some of the policies and strategies described in this report.
Study registration
This study is registered as PROSPERO CRD42016033876 and UKCRN ID number 20700.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
The Centre for Workforce Intelligence (CfWI) have had a long-standing interest in the affordability of options for the healthcare workforce planning. This is ultimately determined by the level of NHS funding available, along with the remuneration and efficiency of the workforce.
In this paper we analyse long-term trends in government healthcare expenditure in the United Kingdom, measured as a proportion of GDP, share of government spending and in real per capita basis.
Preliminary findings highlighted in the report include:
* Like other OECD countries, government healthcare expenditure in the UK has increased markedly since the 1950s in real per capita terms and as a share of total government spending.
* Barring a major crisis, this secular trend is likely to continue in the decades ahead, albeit possibly at a slower pace than in recent decades.
* However, trends over the last 64 years show there are plausible constraints for future healthcare spending which set effective ceilings and floors to future trends in healthcare spending.
* Within those global parameters, large and sustained increases in real healthcare spending per capita can be expected to pose significant affordability challenges for government.
* Conversely, falls in real per capita government healthcare spending are unlikely to be sustainable for a prolonged period. History shows prolonged declines to be rare.
* In recent years we have moved from a period of above-median growth in real per capita government healthcare spending to a period of below-median growth. The current period may come to be seen as an important inflection point for healthcare spending. However, ultimately we expect to see regression to the median in healthcare spending.
The paper also identifies several potential areas for further research.
This is a medium-term strategic review looking ahead to 2030, designed to provide the evidence base for forecasting workforce demand and supply, to enable sustainable improvements in planning for the GP workforce of the future.
The focus of this review is on GPs who have completed their Certificate of Completion of Training (CCT holders).
The CfWI concludes that the current level of GPs being trained is inadequate and likely to lead to a major workforce demand-supply imbalance by 2020 unless action is taken. The CfWI suggests HEE consider a substantial increase in GP training numbers plus a number of measures to help boost workforce supply, particularly in the short term, given the significant lead-in time in training new GPs.
The CfWI worked with the General Practice Task Force on this review.
This report presents our preliminary findings for consultation purposes. Please note that as some data and assumptions will be updated for our final forecasts, the analysis and conclusions in our final report may differ from those presented in this report.
Emerging recommendations
We reaffirm our previous recommendation (CfWI, 2011a) that there needs to be a substantial increase in GP training phased in over several years. We consider that achieving and maintaining 3,250 GP trainees per annum is necessary to address future demand, and should be the top priority. A substantial share of this workforce increase should go towards improving support for under-doctored areas to help achieve more equal access to GP services across England.
Given the rapidly changing nature of healthcare and the inherent uncertainties about future demand, however, we also recommend there be periodic reviews of future GP workforce supply and demand every 3–5 years, supported by a stronger evidence base.
Action is also needed to improve the attractiveness of general practice as a career, including promotion among medical students (and possibly earlier). We see merit in seeking to retain the existing workforce, for example ‘retainer schemes’ – particularly in areas where GPs are under most pressure – and providing support for returners through return-to-practice schemes. The GP Task Force is reviewing these areas.
Note: The final GP report was published by CfWI in July 2014 and can be found at: www.cfwi.org.uk
UK general practice faces a workforce crisis, with general practitioner (GP) shortages, organisational change, substantial pressures across the whole health-care system and an ageing population with increasingly complex health needs. GPs require lengthy training, so retaining the existing workforce is urgent and important.
Objectives
(1) To identify the key policies and strategies that might (i) facilitate the retention of experienced GPs in direct patient care or (ii) support the return of GPs following a career break. (2) To consider the feasibility of potentially implementing those policies and strategies.
Design
This was a comprehensive, mixed-methods study.
Setting
This study took place in primary care in England.
Participants
General practitioners registered in south-west England were surveyed. Interviews were with purposively selected GPs and primary care stakeholders. A RAND/UCLA Appropriateness Method (RAM) panel comprised GP partners and GPs working in national stakeholder organisations. Stakeholder consultations included representatives from regional and national groups.
Main outcome measures
Systematic review – factors affecting GPs’ decisions to quit and to take career breaks. Survey – proportion of GPs likely to quit, to take career breaks or to reduce hours spent in patient care within 5 years of being surveyed. Interviews – themes relating to GPs’ decision-making. RAM – a set of policies and strategies to support retention, assessed as ‘appropriate’ and ‘feasible’. Predictive risk modelling – predictive model to identify practices in south-west England at risk of workforce undersupply within 5 years. Stakeholder consultation – comments and key actions regarding implementing emergent policies and strategies from the research.
Results
Past research identified four job-related ‘push’ factors associated with leaving general practice: (1) workload, (2) job dissatisfaction, (3) work-related stress and (4) work–life balance. The survey, returned by 2248 out of 3370 GPs (67%) in the south-west of England, identified a high likelihood of quitting (37%), taking a career break (36%) or reducing hours (57%) within 5 years. Interviews highlighted three drivers of leaving general practice: (1) professional identity and value of the GP role, (2) fear and risk associated with service delivery and (3) career choices. The RAM panel deemed 24 out of 54 retention policies and strategies to be ‘appropriate’, with most also considered ‘feasible’, including identification of and targeted support for practices ‘at risk’ of workforce undersupply and the provision of formal career options for GPs wishing to undertake portfolio roles. Practices at highest risk of workforce undersupply within 5 years are those that have larger patient list sizes, employ more nurses, serve more deprived and younger populations, or have poor patient experience ratings. Actions for national organisations with an interest in workforce planning were identified. These included collection of data on the current scope of GPs’ portfolio roles, and the need for formal career pathways for key primary care professionals, such as practice managers.
Limitations
The survey, qualitative research and modelling were conducted in one UK region. The research took place within a rapidly changing policy environment, providing a challenge in informing emergent policy and practice.
Conclusions
This research identifies the basis for current concerns regarding UK GP workforce capacity, drawing on experiences in south-west England. Policies and strategies identified by expert stakeholders after considering these findings are likely to be of relevance in addressing GP retention in the UK. Collaborative, multidisciplinary research partnerships should investigate the effects of rolling out some of the policies and strategies described in this report.
Study registration
This study is registered as PROSPERO CRD42016033876 and UKCRN ID number 20700.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
The Centre for Workforce Intelligence (CfWI) have had a long-standing interest in the affordability of options for the healthcare workforce planning. This is ultimately determined by the level of NHS funding available, along with the remuneration and efficiency of the workforce.
In this paper we analyse long-term trends in government healthcare expenditure in the United Kingdom, measured as a proportion of GDP, share of government spending and in real per capita basis.
Preliminary findings highlighted in the report include:
* Like other OECD countries, government healthcare expenditure in the UK has increased markedly since the 1950s in real per capita terms and as a share of total government spending.
* Barring a major crisis, this secular trend is likely to continue in the decades ahead, albeit possibly at a slower pace than in recent decades.
* However, trends over the last 64 years show there are plausible constraints for future healthcare spending which set effective ceilings and floors to future trends in healthcare spending.
* Within those global parameters, large and sustained increases in real healthcare spending per capita can be expected to pose significant affordability challenges for government.
* Conversely, falls in real per capita government healthcare spending are unlikely to be sustainable for a prolonged period. History shows prolonged declines to be rare.
* In recent years we have moved from a period of above-median growth in real per capita government healthcare spending to a period of below-median growth. The current period may come to be seen as an important inflection point for healthcare spending. However, ultimately we expect to see regression to the median in healthcare spending.
The paper also identifies several potential areas for further research.
This is a medium-term strategic review looking ahead to 2030, designed to provide the evidence base for forecasting workforce demand and supply, to enable sustainable improvements in planning for the GP workforce of the future.
The focus of this review is on GPs who have completed their Certificate of Completion of Training (CCT holders).
The CfWI concludes that the current level of GPs being trained is inadequate and likely to lead to a major workforce demand-supply imbalance by 2020 unless action is taken. The CfWI suggests HEE consider a substantial increase in GP training numbers plus a number of measures to help boost workforce supply, particularly in the short term, given the significant lead-in time in training new GPs.
The CfWI worked with the General Practice Task Force on this review.
This report presents our preliminary findings for consultation purposes. Please note that as some data and assumptions will be updated for our final forecasts, the analysis and conclusions in our final report may differ from those presented in this report.
Emerging recommendations
We reaffirm our previous recommendation (CfWI, 2011a) that there needs to be a substantial increase in GP training phased in over several years. We consider that achieving and maintaining 3,250 GP trainees per annum is necessary to address future demand, and should be the top priority. A substantial share of this workforce increase should go towards improving support for under-doctored areas to help achieve more equal access to GP services across England.
Given the rapidly changing nature of healthcare and the inherent uncertainties about future demand, however, we also recommend there be periodic reviews of future GP workforce supply and demand every 3–5 years, supported by a stronger evidence base.
Action is also needed to improve the attractiveness of general practice as a career, including promotion among medical students (and possibly earlier). We see merit in seeking to retain the existing workforce, for example ‘retainer schemes’ – particularly in areas where GPs are under most pressure – and providing support for returners through return-to-practice schemes. The GP Task Force is reviewing these areas.
Note: The final GP report was published by CfWI in July 2014 and can be found at: www.cfwi.org.uk