General and Personal Medical Services. England

Transcription

1 General and Personal Medical Services England Published 25 March 2015

2 We are the trusted national provider of high-quality information, data and IT systems for health and social care. This product may be of interest to employers, stakeholders, policy officials, commissioners and members of the public. Interests will range from comparisons of the general practice workforce at local, regional and national levels to managing recruitment, staffing and training and prioritising commissioning. Author: Responsible statistician: Workforce and Facilities Team, Health and Social Care Information Centre Kate Bedford, Programme Manager Version: V1.0 Date of publication: 25 March Copyright 2015, Health and Social Care Information Centre. All rights reserved.

3 Contents Executive Summary 4 Introduction 5 Analysis and Commentary 6 Practitioners by type (excluding Registrars and Retainers) 6 Practitioners by Gender (excluding Registrars and Retainers) 7 GP Retainers 8 GP Registrars (trainees) 8 Practice numbers and size 9 Country of Primary Medical Qualification 10 Practitioner Age 11 Practitioners and the population 13 Type of contract 16 Dispensing Practices 16 Staff in practices 16 Joiners and Leavers 19 UK Comparison of GP Workforce 20 Data Quality 21 General Practice and General Practitioners 21 General Practice Staff 25 Further Information 27 Index to Tables 28 Copyright 2015, Health and Social Care Information Centre. All rights reserved. 3

4 Executive Summary All GPs (Providers, Salaried/Other, Registrars and Retainers) There are 40,584 headcount General Practitioners, an increase of 348 (0.9%) since 2013 and a rise of 5,729 (16.4%) since 2004 (an average annual increase of 1.5%). This represents 36,920 Full Time Equivalent (FTE) GPs, an increase of 626 (1.7%) since 2013 and an increase of 5,899 (19.0%) since 2004 (an average annual increase of 1.8%). GPs excluding Registrars (i.e. trainees) and Retainers There are 32,628 FTE GPs, an increase of 553 (1.7%) since 2013 and 4,320 (15.3%) more since 2004 (an annual average increase of 1.4%). This represents 35,819 headcount GPs, an increase of 258 (0.7%) since 2013 and an increase of 4,296 (13.6%) since 2004 (an average annual increase of 1.3%). There are 23,763 FTE GP providers, a decrease of 279 (1.2%) since 2013 and a decrease of 2,416 (9.2%) since 2004 (an annual average decrease of 1.0%). This represents 26,183 headcount GP providers, a decrease of 452 (1.7%) since 2013 and a decrease of 2,598 (9.0%) since 2004 (an average annual fall of 0.9%). FTE of Other GPs (typically salaried practitioners) now numbers 8,865, an increase of 833 (10.4%) since 2013 and an increase of 6,736 (316.4%) since 2004 (an annual average increase of 15.3%). This represents 9,885 headcount Other GPs, an increase of 732 (8.0%) since 2013 and an increase of 7,143 (260.5%) since 2004 (an average annual increase of 13.7%). All GPs by gender (Providers, Salaried/Other, Registrars and Retainers) There are 18,301 FTE females within the GP workforce, an increase of 5.4 per cent (941) since Male FTE GPs number 18,619, a decrease of 1.7 per cent (314) since This represents 21,195 headcount females and 19,389 headcount males in 2014, an increase of 3.7 per cent (760) for the former and a decrease of 2.1 per cent (412) for the latter since There has been an increase of 58.4 per cent (6,750) in females (FTE) since 2004, whereas male numbers have decreased by 4.4 per cent (851). This represents an increase of 46.0 per cent (6,676) in headcount females since 2004, whereas male headcount has decreased by 4.7 per cent (947). Practice staff There are 23,832 headcount Nurses, a decrease of 1 (less than 0.01%) since This represents 15,062 FTE Nurses, an increase of 119 (0.8%) since There are 115,520 headcount Practice Staff (excluding Nurses), an increase of 1,297 (1.1%) since This represents 73,334 FTE Practice Staff (excluding Nurses), a rise of 1,133 (1.6%) since Copyright 2015, Health and Social Care Information Centre. All rights reserved.

5 Introduction This statistical bulletin relates to General Practices contracted to the NHS in England. The data is collected from the NHS General Practice payments system and also through returns supplied by NHS England Area Teams and Clinical Commissioning Groups (CCGs). Comprehensive definitions can be found later in this bulletin. It is important to understand the term General Practice and what it means in terms of this bulletin. It is defined as an organisation which offers Primary Care medical services by a qualified General Practitioner who is able to prescribe medicine and where patients can be registered and held on a list. Generally, the term describes what is traditionally thought of to be a high street family doctor s surgery. For the purposes of this bulletin the term General Practice does not include Prisons, Army Bases, Educational Establishments, Walk-In Centres or Specialist Care Centres including Drug Rehabilitation Centres. This bulletin is one of four that make up the NHS Staff publication, the others being: NHS Workforce: Summary of staff in the NHS: Results from September 2014 Census NHS Hospital and Community Health Services: Medical and Dental staff, in England , as at 30 September NHS Hospital and Community Health Services: Non-medical staff, in England , as at 30 September Summary details of all NHS staff can be found on Tables 1a and 1b of this bulletin. Recent Consultation on this Publication The HSCIC consulted users on changes to the way the information used to produce these statistics 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 also captured users requirements in respect of the changes following the future implementation of the Workforce Minimum Dataset (wmds). The wmds will going forward be the source data for this publication and will predominantly be provided via a web-based tool. The wmds will replace the current data sources, see data quality section of this publication for details of the current sources. More information relating to wmds can be found at: The consultation closed in Feb 2015 with a total 26 responses. The results from the consultation will be published on the HSCIC website. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 5

6 Headcount General and Personal Medical Services: England Analysis and Commentary Practitioners by type (excluding Registrars and Retainers) Figure 1: Practitioner Headcount ,000 35,000 30,000 25,000 20,000 15,000 10,000 Practitioners GP Providers Salaried/Other GPs 5, ¹ Year - at 30 September ¹ The new headcount methodology is not fully comparable with data for years prior to 2010, due to improvements that make it a more stringent count of absolute staff numbers. Headcount totals are unlikely to equal the sum of components. Further information on the headcount methodology is available in the data quality section contained within the overview Census publication. Between 2004 and 2014 the total number of practitioners (headcount) rose by 13.6%, to 35,819; the number of GP Providers has however fallen by 9.0% since 2004 to 26,183 in 2014 and down from the 2005 high of 29,340. The number of salaried/other practitioners (headcount) shows an increase of 7,143 since 2004; this 260.5% increase from 2,742 to 9,885 in 2014 indicates the continuing trend to work in General Practice for a salary rather than as a partner. This can be seen across both male and female salaried/other GPs who have seen an average annual rise of 11.3% and 14.9% respectively since The measure of full time equivalent practitioners increased to 32,628 in 2014 from 32,075 in 2013, an increase of 1.7%. Since 2004 there has been an increase of 15.3%. As highlighted in the data quality statement for Full Time Equivalent (FTE), this 10 year change should however be treated with caution. 6 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

7 Full Time Equivalent Headcount General and Personal Medical Services: England Practitioners by Gender (excluding Registrars and Retainers) Figure 2: Practitioners (excluding Registrars and Retainers) by Gender (Headcount) 22,500 20,000 17,500 15,000 12,500 10,000 7,500 5,000 2,500 0 Male Female ¹ Year - at 30 September ¹ The new headcount methodology is not fully comparable with data for years prior to 2010, due to improvements that make it a more stringent count of absolute staff numbers. Headcount totals are unlikely to equal the sum of components. Further information on the headcount methodology is available in the data quality section contained within the overview Census publication. Since 2004 female practitioner headcount has increased by 5,653 (46.2%) from 12,235 in 2004 to 17,888 in 2014 (an average annual change of 3.9%), with their proportion rising from 38.8% in 2004 to 49.9% in Since 2013 the number of male practitioners has fallen by 399 (2.2%) whilst female practitioners rose by 657 (3.8%) over the same period. In FTE terms male practitioners have fallen to 17,205 in 2014, down 306 since last year and 1,766 since the peak in 2006; FTE female practitioners have risen by 5.9% in the last year to 15,423, continuing the upward trend with an annual average increase of 4.6% since Figure 3: Practitioners (excluding Registrars and Retainers) by Gender (FTE) 20,000 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2, Year - at 30 September Male GP Providers Female GP Providers Female Salaried/ Other GPs Male Salaried/ Other GPs Copyright 2015, Health and Social Care Information Centre. All rights reserved. 7

8 Age General and Personal Medical Services: England GP Retainers Retainers are practitioners who provide service sessions in general practice. They are employed to undertake set sessions, being allowed to work a maximum of 4 sessions per week. The headcount number of retainers is down by 66.0% from 770 in 2004 to 262 in Over the same time the FTE of retainers has decreased by 142 (55.1%). GP Registrars (trainees) The number of GP Registrars (headcount) has increased from 2,562 in 2004 to 4,512 in 2014, an average annual growth rate of 5.8%. Since 2013 GP Registrar headcount has grown by 2.5 per cent (108). Figure 4: Registrars by Gender and Age at 30 September 2014 (Headcount) Female Male Headcount 3,056 (headcount) female registrars work in general practice, an increase of 1,517 (98.6%) since 2004 (annual average increase of 7.1%). The male registrar headcount in 2014 is 1,456, an increase of 433 (42.3%) since 2004 (an average annual increase of 3.6%). The gender split for registrars has increased from 60.1% female in 2004 to 67.7% in It is recommended that counts of trainees currently in Primary Care be read in conjunction with those on hospital rotation listed in table 3.1 of the Medical and Dental Staff Census. 8 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

9 Practice numbers and size Map 1: Average number of Patients per Practice at 30 September 2014 by Clinical Commissioning Group In 2014 there were 7,875 general practices in England, a decrease of 87 (1.1%) on last year. We continue to exclude, where possible, other prescribing locations like hospices, out-ofhours and most walk-in centres, although the increasing trend for the latter to develop as Equal Access Treatment Centres that register patients now makes it harder to distinguish them from true general practices. The number of patients per practice has grown steadily in the last decade rising from 6,149 to 7,171 between 2004 and 2014, reflecting the move towards larger practices. Average practice list size varies between 5,477 in Merseyside Area Team and 9,203 in Thames Valley Area Team. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 9

10 Total registered patients in England have increased from 56.0 million in 2013 to 56.5 million (0.8%). It should be noted that ONS resident population for 2014 is however only 53.9 million based on mid-year 2013 estimates from the 2011 Census. This discrepancy is known as list inflation and may be due to patients being registered at a general practice who no longer exist due to death, emigration or moving home (often called ghosts ), or due to registered patients not completing the 2011 Census (for example, patients who are refugees or homeless) 1. In 2014 there are 1,369 single-handed GP providers, a fall of 35 (2.5%) from 2013 and a fall of 40.1% since A single-handed GP provider is one who has no partners, although they may employ a GP Other, GP Registrar or GP Retainer. The count of single-handed practices is now 843 or 10.7% of the total, less than half the number in A singlehandled practice is a practice which only has one working (Provider or Other) GP, although a GP Registrar or GP Retainer may work in the practice. Country of Primary Medical Qualification There continues to be little change in the proportions of practitioners (headcount) obtaining their primary medical qualification in the United Kingdom (UK), European Economic Area (EEA) and elsewhere over the last ten years. In 2014, 77.7% of practitioners had qualified in the UK, down slightly from 81.2% in 2004, with growth coming mainly from Africa and South Asia. The percentage of GPs qualified in South Asia has risen to 12.6% in 2014 from 10.5% in Figure 5a: Practitioner (excluding Registrars and Retainers) Country of Qualification - main groups at 30 September 2014 (Headcount) United Kingdom South Asia EEA Africa Other 12.6% 4.5% 3.0% 2.3% 77.7% The proportion of GP Registrars (headcount) obtaining their primary medical qualification in the UK has risen from 63.5% (1,627) in 2004 to 79.5% (3,585) in As a result the proportion of GP Registrars obtaining their primary medical qualification outside of the UK has fallen, but the absolute number of these GP Registrars has remained largely unchanged (935 in 2004; 927 in 2014). Figure 5b: Registrars Country of Qualification - main groups at 30 September 2014 (Headcount) United Kingdom South Asia EEA Africa Other 10.6% 2.7% 3.9% 3.3% 79.5% 1 Ashworth, M, Jenkins, M, Burgess, K, Keynes, H, Wallace, M, Roberts, D, & Majeed, A (2005), 'Which general practices have higher list inflation? An exploratory study', Family Practice, 22, 5, pp Copyright 2015, Health and Social Care Information Centre. All rights reserved.

11 Map 2: Percentage of Practitioners (excluding Registrars and Retainers) qualified outside the UK at 30 September 2014 by Clinical Commissioning Group (Headcount) Practitioner Age England has 7,816 practitioners aged 55 and over, an increase in the proportion from 20.4% in 2004 to 21.9% in 2014, with the proportion under 35 also rising from 11.9% to 12.8% over the same period. Regionally, Kent and Medway Area Team has the highest proportion of practitioners 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%. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 11

12 Age Age General and Personal Medical Services: England Figure 6: Providers by Gender and Age at 30 September 2014 (Headcount) Female Male Headcount Figure 7: Salaried/Other GPs by Gender and Age at 30 September 2014 (Headcount) Female Male Headcount 12 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

13 Map 3: Percentage of Practitioners (excluding Registrars and Retainers) aged 55 and over by Clinical Commissioning Group (Headcount) Practitioners and the population Headcount GP numbers (excluding Registrars and Retainers) since 2004 have increased by an annual average rate of 1.3%; this is higher than the rate of growth in the population, resulting in 66.5 practitioners per 100,000 ONS resident population in 2014 compared to 62.9 in Copyright 2015, Health and Social Care Information Centre. All rights reserved. 13

14 Regionally, London has 65.6 practitioners (excluding Registrars and Retainers) per 100,000 population, which is slightly less than the England average of This compares with highs of 79.0 in Devon, Cornwall and Isles of Scilly Area Team and 77.9 in the Bristol, North Somerset, Somerset and South Gloucester Area Team. Essex Area Team and Kent and Medway Area Team have the lowest numbers with 55.2 and 60.0 respectively. Map 4: Number of Practitioners (excluding Registrars and Retainers) per 100,000 population at 30 September 2014 by Clinical Commissioning Group (Headcount) 14 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

15 Map 5: Average number of Patients per Practitioner (excluding Registrars and Retainers) at 30 September 2014 by Clinical Commissioning Group (Headcount) Average GP List sizes range from 1,313 patients per practitioner in the Devon, Cornwall and Isles of Scilly Area Team to 1,870 in the Essex Area Team. Over the last ten years, the average number of patients per headcount practitioner has fallen from 1,666 in 2004 to 1,577 in 2014, but has risen slightly in each of the last three years from 1,562 in Copyright 2015, Health and Social Care Information Centre. All rights reserved. 15

16 Type of contract Figure 8: Contract Type of Practices - at 30 September 2014 GMS 56.1% PMS 39.9% APMS 2.4% APMS by Limited Company PMS by Limited Company GMS by Limited Company 1.3% 0.2% 0.1% In 2014 there are 4,421 practices (56.1%) holding General Medical Service (GMS) contracts; there are also a small number of GMS Contracts (7) held by limited companies. There are 3,143 (39.9%) Personal Medical Service (PMS) contracts in 2014, down slightly from 3,197 in 2013, with some PMS contracts also being held by limited companies (14). In 2014 there are 290 practices who have Alternative Personal Medical Service (APMS) contracts, an increase from 271 in 2013, of which now just over a third (99) are administered privately. Dispensing Practices Although most Practitioners just prescribe, some are also authorised to dispense prescriptions under the National Health Service (Pharmaceutical Services) Regulations A GP may be authorised to dispense to patients living in a controlled locality like a rural area who would have difficulty reaching a chemist or pharmacy. The number of dispensing practices has fallen by 99 over the last ten years; however as a proportion of the total they have remained roughly the same, 13.6% (1,162) in 2004 to 13.5% (1,063) in Staff in practices To deliver primary care, practitioners work closely with nurses, health care assistants, managers, administrators and others involved with direct patient care (e.g. physiotherapists, chiropodists). This bulletin details only those staff employed directly by the practices. Please refer to the Data Quality statement in this bulletin for a detailed clarification of improvements to the data collection coverage. Due to these improvements, information prior to 2010 is not comparable. 16 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

17 Full Time Equivalent General and Personal Medical Services: England Figure 9: Practice Staff , , , , ,000 90,000 80,000 70,000 60,000 Headcount Full Time Equivalent ¹ Year - at 30 September ¹ Prior to 2010 General Practice staff information was collected at an aggregated Primary Care Trust level with the completeness of such returns at practice level being unknown. Data prior to 2010 may not be directly comparable with subsequent years. The overall headcount of practice staff rose by 0.9% between 2013 (138,056) and 2014 to 139,352. FTE numbers rose by 1.4% from 2013 to 88,396 in Although the number of practices has fallen this year, patient numbers have continued to rise. Practice staff FTE for nurses combined with other direct care functions has increased by 1.9% in 2014 to 24,340 from 23,889 in Figure 10: Practice Staff by type (FTE) 90,000 80,000 70,000 60,000 50,000 All Practice Staff Admin & Clerical All Nurses Direct Patient Care 10,000 Other ¹ Year - at 30 September ¹ Prior to 2010 General Practice staff information was collected at an aggregated Primary Care Trust level with the completeness of such returns at practice level being unknown. Data prior to 2010 may not be directly comparable with subsequent years. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 17

18 The number of FTE nurses working in practices has increased by 0.8% since 2013 with 15,062 in FTEs of other staff involved in direct patient care (including health care assistants) are now 9,277 showing a growth of 3.7% since 2013, continuing the longer term trend. Map 6 - Average Number of Patients per Headcount nurse at 30 September 2014 by Clinical Commissioning Group Note: figures used to plot all maps are available in the General Practice Detailed Tables 2014 available at: 18 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

19 Headcount Leavers Headcount Joiners Headcount General and Personal Medical Services: England Joiners and Leavers Figure 11: Net change in Headcount GPs (excluding Registrars and Retainers) by Gender ,750 Male Female All GPs 1,500 1,250 1, Between 2013 and 2014, 3,048 GPs (excluding Registrars and Retainers) joined the profession. This represented 8.5% of the GP workforce (excluding Registrars and Retainers) in Of the 2013 GP workforce (excluding Registrars and Retainers), 2,787 (7.8%) left the profession between 2013 and Joiners to the 2014 workforce consisted of 1,942 females and 1,106 males. There continues to be more males leaving the profession than females. Figure 12: Headcount of GP (excluding Registrars and Retainers) Joiners and Leavers by Gender ,750 1, ,250 1,750 F M F M F M F M F M F M F M F M F M F M Copyright 2015, Health and Social Care Information Centre. All rights reserved. 19

20 UK Comparison of GP Workforce Since 2004, GP Headcount has increased across the four countries. Between 2004 and 2014 England has seen the largest increase in GP headcount (13.6%) with Scotland showing the smallest increase (8.6%). Overall practitioner numbers for the four countries combined have increased slightly over the last year. Wales has seen a decrease of 1.0% (20 headcount GPs) in the last year whilst the England, Scotland and Northern Ireland have all seen an increase. The number of GPs per 10,000 population has increased in England, Wales and Scotland since These figures are not yet available for Northern Ireland for Scotland has the highest number of GPs per 10,000 population at 8.1. Northern Ireland has the highest percentage of GPs aged 55 or over at 24.0% compared to the lowest percentage of 19.6% in Scotland. The percentage of GPs that are female has increased in all 4 countries between 2013 and More than half of all GPs in Scotland (53.3%) are female. 20 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

21 Data Quality A full data quality statement can be found in the 2014 NHS Workforce Census Bulletin at Table Conventions Full time equivalent (FTE) figures appear rounded to the nearest whole number. Totals may not add to the sum of their components as a result of rounding. The following general notes apply to all tables; additional notes affecting individual tables are given as footnotes to the table. The following symbols have been used in tables:.. not available - zero. not applicable 0 more than zero but less than 0.5 General Practice and General Practitioners Data Sources The NHAIS (Exeter) General Practice Payments System, a computerised payment system of General Medical Practitioners in England, is the main source of General Practice and Practitioner information. It includes details of each practitioner s name, date of birth, gender, working hours/sessions, practice details and whether certain allowances are payable. Additional information about GPs not recorded on the system is supplied manually by Clinical Commissioning Groups (CCGs) via secure electronic data transfer. The data relates to the 30 September in each year. Population estimates for mid-year 2013 figures (based on 2011 Census) issued by the Office of National Statistics have been used to calculate the number of practitioners per 100,000 population. Methodology The Census headcount methodology changed in An explanation of the method used from 2010 onwards is available on the next page and in more detail in the 2014 NHS Workforce Census Bulletin at Copyright 2015, Health and Social Care Information Centre. All rights reserved. 21

22 A simple example of how the new headcount methodology for the Workforce Census data from 2010 and beyond will count a member of staff who works across 2 Practices, 0.2 of their time at Practice A and 0.8 of their time at Practice B, is shown in the table below: Headcount FTE Role / Contract count National Regional Practice A Practice B Headcount refers to individual staff in part or full time roles. Subtotals of headcounts such as NHS England Area Team totals are unlikely to add up to national figures. At national level an individual working two or more part time roles in more than one Area Team will be counted once but would appear in headcount figures at each of the Area Teams. FTE is the full time equivalent and is based on the proportion of time staff work in a role. Contract/role count is the total count of specific posts held/worked within a given organisational level. Some GPs may have multiple roles either within or across geographical organisations. Definitions This bulletin only includes those practitioners who are authorised to practice within England. All tables and figures in this bulletin exclude GP Locums. A General Practitioner is a medical practitioner who treats all illnesses and provides preventative care and health education for patients of all ages. All Practitioners include GP Providers, Salaried/Other GPs, Registrars and Retainers. Practitioners are All Practitioners excluding Registrars and Retainers. A GP Provider is a practitioner who has entered into a contract to provide services to patients. These practitioners were formerly known as Contracted and Salaried GPs. Following the introduction of the new GP contract in 2004, the Exeter computer system recording GP numbers was refined. Prior to 2004 all GPs on the Exeter system were classified as GP Providers, the revision allowed all GP types to be included. Previously, numbers of Other GPs, Registrars and Retainers came from Primary Care Trusts on separate returns. Therefore, in 2004 and 2005 some non-providers, but not all, were included on the system and will be included in the GP Provider figure for these years. From the 2006 census onwards, the Exeter system was able to identify those non-provider GPs. Salaried/other GPs work within partnerships and were formerly known as GMS or PMS Others. These practitioners are generally remunerated by salary. GP Retainers are practitioners who provide service sessions in general practice. They are employed by the partnership to undertake set sessions, being allowed to work a maximum of 4 sessions per week. 22 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

23 A GP Registrar is a fully registered physician who is being trained for general practice under an arrangement approved by the Secretary of State. A General Practice is an organisation which offers Primary Care medical services by a qualified General Practitioner who is able to prescribe medicine and where patients can be registered and held on a list. Generally, the term describes what is traditionally thought of to be a high street family doctor s surgery. For the purposes of this bulletin the term General Practice does not include Prisons, Army Bases, Educational Establishments, Specialist Care Centres including Drug Rehabilitation Centres and Walk-In Centres, although the increasing trend for Walk-In Centres to develop as Equal Access Treatment Centres that register patients now makes it harder to distinguish them from true general practices and as such these centres are included within this bulletin. A Single-Handed GP Provider is one who works alone without other partner practitioners, although a Salaried/Other GP, GP registrar or GP retainer may work in the practice. A Single-Handed Practice is a practice which has only 1 working (Provider or Salaried/Other) GP, although a GP registrar or GP retainer may work in the practice. The primary medical qualification used to identify the country of qualification is based on information held on each individual doctor on the GMC register. The countries are grouped into UK, European Economic Area (EEA) and Elsewhere. Historical figures are based on the current EEA membership for comparability. See Selected Country of Qualification groupings later in this section. NHS England is the preferred name for NHS Commissioning Board. NHS England s main areas of work are: Improving patient experience Commissioning Technology, systems and data Partnerships and relationships Direct commissioning Quality improvement and clinical leadership Our governing frameworks Patient safety Patient involvement Strategic and Operational Planning 2014 to 2019 Further information on NHS England is available at NHS England Area Teams (ATs) are localised regions within NHS England. The role of area teams is to commission high quality primary care services, support and develop CCGs and assess and assure performance. They manage and cultivate local partnerships and stakeholder relationships, including representation on health and wellbeing boards. Clinical Commissioning Groups (CCGs) were established as statutory organisations from April CCGs are groups of GP Practices responsible for buying health and care services for patients, taking over the role from Primary Care Trusts. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 23

24 Primary Care Trusts (PCTs) were free standing statutory bodies with their own budget for local health care. They commissioned the bulk of hospital and community health services for their local population and were able to provide health and other services. As a result of the Health and Social Care Act 2012, from 1st April 2013, responsibility for commissioning healthcare transferred away from PCTs to CCGs. General Medical Services (GMS) is the contract under which most GPs are employed. It is a national agreement between the provider and NHS England which sets out the financial arrangements, the services to be provided and support arrangements. Personal Medical Services (PMS) were first introduced in They allow the provider to negotiate a local agreement for the services they will provide and payments they will receive, taking into account specific local healthcare needs. Alternative Provider Medical Services (APMS) allow contracts to be bid for by the private, voluntary and public sectors. They offer greater flexibility in the nature of service provision which is decided in agreement between the provider and the commissioner. Full Time Equivalent (FTE) is a standardised measure of the workload of an employee. An FTE of 1.0 means that a person is equivalent to a full time worker, an FTE of 0.5 signals that the worker is half (part) time. Note: 1 FTE is equivalent to 37.5 hours. This measure allows for the work of part-time staff to be converted into an equivalent number of full time staff. In 2006, GP FTE data (for most GPs) was entered directly onto the Exeter system for the first time; consequently comparisons with previous years need to be treated with some caution. For 2005 and 2004 FTE factors were estimated from the results of the GMP workload survey using factors of 1.0 full time and 0.6 part-time. FTE Retainers have been estimated using a factor of 0.12 per session. Prior to 2004, FTE figures were estimated using factors of 1.0 full time, 0.69 three quarter time, 0.65 job share and 0.6 half time. Average number of Patients per Practitioner is the total number of patients registered at the practice divided by the headcount/fte of practitioners working at that practice. Joiners and Leavers A leaver is a GP who was working (as a GP Provider/Salaried/Other GP) at an English practice in one census but was not a GP Provider/Salaried/Other GP at an English practice the following year. A joiner is a GP who was working (as a GP Provider/Salaried/Other GP) at an English practice in one census but was not a GP Provider/Salaried/Other GP at an English practice the previous year. If a GP was working as a registrar at the 2013 census and then took up a position as a GP Provider/Salaried/Other GP they will be counted as a Joiner. Selected Country of Qualification groupings EEA is the European Economic Area excluding UK, as such comprises Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Irish Republic, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden and Switzerland. South Asia includes Bangladesh, India, Maldive Islands, Nepal, Pakistan and Sri Lanka. 24 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

25 General Practice Staff Data Sources In % of practices provided a Practice Staff Return, compared to 90.0% in Figures for the remaining practices were estimated to give a full census figure. The same methodology was applied in 2012 and 2013, and retrospectively to figures for 2010 and 2011 with the previously published data revised in 2012 to enable full comparability over the last 5 years. Details of the estimation process can be found in the methodology section. Prior to 2010 General Practice staff information was collected at an aggregated Primary Care Trust level with the completeness of such returns at practice level being unknown. Data prior to 2010 may not be directly comparable with subsequent years. Methodology All staff (excluding General Practitioners) employed by a practice are included in the Practice Staff Census. Further details of the staff and staff groups included can be found in the definitions below. Practices are required to provide contracted hours and headcount information aggregated for each staff group. Definitions Contracted Hours is the total aggregated number of hours worked by each staff group. Headcount is the simple count of actual people/staff working within a Practice regardless of the hours they may work. Full Time Equivalent (FTE) is a standardised measure of the workload of an employed person. An FTE of 1.0 means that the hours a person works is equivalent to a full time worker, an FTE of 0.5 signals that the worker is half time. This measure allows for the work of part-time staff to be converted into an equivalent number of full time staff. It is calculated by dividing the total number of hours worked by staff in a specific staff group by Estimating missing data ( ). This is an improved methodology from that used previously to better estimate data for practices for which information is not available. Those practices for which information has been received are split into 8 groups according to their registered patient size. An average full time equivalent and headcount per patient for each staff category is calculated for each group of practices. The size of those practices with missing data is then used to place them into one of the 8 groups and the relevant averages are used to estimate the missing data by multiplying the average by the number of registered patients. Estimates are used to produce aggregate totals. Estimating missing data ( ). Those practices for which information was received in the relevant year are split into 8 groups according to registered patient size. An average full time equivalent and headcount for each staff category is calculated for each group of practices. The relevant average is applied to those practices with missing data according to the practice s registered patient size. Estimates are used to produce aggregate totals. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 25

26 Nurses working in General Practice In 2013 the Nurse category was divided into 3 sub-categories: Prior to 2013 these categories were all classed as Practice Nurses: 1. Advanced Level Nurses includes Advanced Nurse Practitioner, Nurse Practitioner, Prescribing Nurse, Nurse Clinician, Nurse Manager, Practice Development Nurse, Physician Associate and Assistant Practitioner. These nurses have high levels of clinical skill, competence and autonomous decision-making. 2. Extended Role & Specialist Nurses includes Extended Role Nurses and practice nurses who have received additional training in a specialist area such as Diabetes, Asthma, Learning Disability, Mental Health and Sexual Health and includes Community Nurses or Midwives, Health Visitors, School Nurses etc. if they are directly employed by the Practice. 3. Practice Nurses include all other qualified nurses employed by the practice. Direct Patient Care: Anyone who is directly involved in delivering patient care but who is not a nurse or GP. This includes Health Care Assistants (HCAs), Physiotherapists, Pharmacists, Phlebotomists, Chiropodists, Dispensers, Counsellors, Complementary Therapists etc. Administrative/Clerical: Anyone who is involved in the administration or organisation of the GP Practice. This includes Practice Managers, Receptionists, Secretaries, IT/Computing Specialists, Link workers, Interpreters, General Office Staff etc. Other: Any paid/employed member of practice staff who is not included in any other staff group. For example Gardeners, Cleaners etc. 26 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

27 Further Information Data tables providing information at National, Regional, Health Education England Local Education Training Board, NHS England Area Team, Clinical Commissioning Group and GP Practice level for 2014 and a time series for years can be found at: Other NHS Staff Bulletins This bulletin is one of four that make up the NHS Staff publication, the others being: NHS Workforce: Summary of staff in the NHS: Results from September 2014 Census NHS Hospital and Community Health Services: Medical and Dental staff, in England , as at 30 September NHS Hospital and Community Health Services: Non-medical staff, in England , as at 30 September These are available at: More detailed data on General and Personal Medical Services as well as Non-Medical Staff and Medical and Dental staff are also available from this website. Dental General Practice Data on General Dental Practitioners (high-street dentists) are available at: General Ophthalmic Services Data on the workforce within General Ophthalmic Services are available at: Copyright 2015, Health and Social Care Information Centre. All rights reserved. 27

28 Index to Tables Table Description Table 1a: Table 1b: NHS Hospital & Community Health Service (HCHS) and General Practice workforce as at 30 September each specified year, headcount, NHS Hospital & Community Health Service (HCHS) and General Practice workforce as at 30 September each specified year, full time equivalents, Table 2a: General Medical Practitioners: analysis by gender and status, headcount, Table 2b: Table 2c: General Medical Practitioners: analysis by gender and status, full time equivalents, General Medical Practitioners: analysis by gender and status, contract count, Table 3: Selected Practice statistics, Table 4: Type of contract coverage of GMS, PMS & other, Table 5a: Practitioners (excluding Registrars & Retainers) by country of primary medical qualification, Table 5b: Registrars by country of primary medical qualification, Table 6: Practitioners (excluding Registrars & Retainers) by age band, Table 7: Practitioners (excluding Registrars & Retainers): joiners and leavers, Table 8: Full-time Equivalent work commitment by GP type (excluding Registrars & Retainers) Table 9: General Practice staff by type: Headcount & Full Time Equivalent, Table 10: UK comparisons of GP workforce, Copyright 2015, Health and Social Care Information Centre. All rights reserved.

29 Table 1a: NHS Hospital & Community Health Service (HCHS) and General Practice workforce as at 30 September each specified year England headcount & percentages Change % change Change Average Annual % Total 1,260,860 1,298,202 1,284,261 1,272,884 1,308,774 1,365,303 1,387,191 1,361,533 1,358,295 1,364,165 1,387,692 23, % 126, % Total HCHS medical and dental staff (incl HPCAs) 86,996 90,630 93,320 94,638 98, , , , , , ,632 1, % 23, % Total HCHS non-medical staff 1,030,800 1,063,121 1,038,368 1,027,299 1,060,629 1,110,138 1,109,195 1,083,637 1,075,035 1,078,425 1,098,170 19, % 67, % Total GPs 34,855 35,944 36,008 36,420 37,720 40,269 39,409 39,780 40,265 40,236 40, % 5, % Total GP Practice staff 6 112, , , , , , , , , , ,352 1, % 27, % Professionally qualified clinical staff 622, , , , , , , , , , ,872 9, % 79, % All doctors 2 117, , , , , , , , , , ,273 2, % 32, % Consultants (including Directors of public health) 30,650 31,993 32,874 33,674 34,910 36,950 37,752 39,088 40,394 41,220 42,733 1, % 12, % Registrars 16,823 18,006 18,808 30,759 35,042 37,108 38,158 38,891 39,404 40,492 41, % 24, % Other doctors in training and equivalents 24,874 26,305 27,461 16,024 14,136 14,394 14,034 14,018 13,952 14,118 14, % -10, % Hospital practitioners and clinical assistants (non-dental specialties) 2 4,045 3,587 3,077 2,848 2,761 2,333 2,148 1,782 1,547 1,254 1, % -3, % Other medical and dental staff 10,604 10,739 11,100 11,333 11,854 12,176 12,223 12,292 12,302 11,983 12, % 1, % GPs total 34,855 35,944 36,008 36,420 37,720 40,269 39,409 39,780 40,265 40,236 40, % 5, % GPs (excluding retainers and registrars) 31,523 32,738 33,091 33,364 34,010 35,917 35,120 35,415 35,527 35,561 35, % 4, % GP Providers 28,781 29,340 27,691 27,342 27,347 27,613 27,036 27,218 26,886 26,635 26, % -2, % Other GPs 2,742 3,398 5,400 6,022 6,663 8,304 8,319 8,585 8,898 9,153 9, % 7, % GP registrars 5,7 2,562 2,564 2,278 2,491 3,203 3,881 3,880 4,013 4,426 4,404 4, % 1, % GP retainers % % Total qualified nursing staff 3 358, , , , , , , , , , ,191 5, % 18, % Qualified nursing, midwifery & health visiting staff 336, , , , , , , , , , ,359 5, % 16, % GP practice nurses 6 22,144 22,904 23,797 22,860 22,048 21,935 23,846 23,584 23,458 23,833 23, % 1, % Total qualified scientific, therapeutic & technical staff 8 128, , , , , , , , , , ,960 1, % 27, % Qualified Allied Health Professions 65,515 67,841 67,483 68,687 71,301 73,953 74,374 74,647 74,902 76,163 77,947 1, % 12, % Qualified Healthcare Scientists 28,242 30,046 30,453 30,158 30,925 32,161 31,972 31,481 31,173 29,617 27,368-2, % % Other qualified scientific, therapeutic & technical staff 35,126 36,647 36,562 38,131 40,229 43,265 45,337 46,167 47,490 48,429 50,728 2, % 15, % Qualified ambulance staff 4 17,272 18,117 16,176 17,028 17,451 17,922 18,450 18,687 18,645 18,734 18, % 1, % Support to clinical staff 336, , , , , , , , , , ,402 11, % 24, % Support to doctors & nursing staff 271, , , , , , , , , , ,498 7, % 10, % Support to scientific, therapeutic & technical staff 55,025 55,715 54,307 53,259 55,792 60,048 62,726 62,057 61,345 61,312 64,502 3, % 9, % Support to ambulance staff 9,630 10,063 12,472 11,443 13,067 14,362 14,738 14,238 13,451 14,112 14, % 5, % NHS infrastructure support 211, , , , , , , , , , , % % Central functions 99, , , , , , , , , , ,178 2, % 6, % Hotel, property & estates 73,932 75,431 70,776 71,102 73,797 75,624 74,712 72,283 71,242 70,892 69,053-1, % -4, % Manager & senior manager 37,726 39,391 36,751 36,499 39,913 44,661 41,962 38,214 37,314 36,360 37, % % Other non-medical staff or those with unknown classification % % Other GP practice staff 6 90,110 89,190 95,845 94,515 92,436 92, , , , , ,520 1, % 25, % Notes: 1 The new headcount methodology is not fully comparable with data for years prior to 2010, due to improvements that make it a more stringent count of absolute staff numbers Headcount totals are unlikely to equal the sum of components. Further information on the headcount methodology is available in the Census publication. 2 In order to avoid double counting Hosptial Practitioners & Clinical Assistants (HPCAs) are excluded from the all doctors totals, as they are predominantly GPs that work part time in hospitals (applies to headcount data only). 3 Nursing and midwifery figures exclude students on training courses leading to a first qualification as a nurse or midwife. 4 In 2006 ambulance staff were collected under new, more detailed, occupation codes. As a result, qualified totals and support to ambulance staff totals are not directly comparable with previous years. 5 GP Registrar count from 2008 onwards represents an improvement in data collection processes and comparisons with previous years should be treated with caution 6 Practice staff figures for 2010 & 2011 were revised in Further details can be found in the data quality statement/methodology. This will affect any related totals and comparisons with years prior to From 2012 GP Registrars have been removed from the GP Workforce collection where a duplicate record already exists on the Electronic Staff Record. Due to a change in coding practices in some regions GP Registrars are increasingly recorded on the ESR system rather than the GP Exeter Payment System. All these staff are not shown in the GP Registrar totals but are included in the HCHS Medical and Dental Registrars total 8 A reclassification of healthcare scientists in 2013/14 has led to a shift in numbers within qualified scientific, therapeutic and technical staff, this affects 2014 data. These statistics relate to the contracted positions within English NHS organisations and may include those where the person assigned to the position is temporarily absent, for example on maternity leave. From 2011 the bank staff return was suspended (and formally ceased in 2013). All data (for all years) in these tables excludes bank staff From April 2013 Public Health England was excluded from workforce publications. Copyright 2015 Health and Social Care Information Centre. All rights reserved

30 Table 1b: NHS Hospital & Community Health Service (HCHS) and General Practice workforce as at 30 September each specified year England full time equivalent & percentages Change % change Change Average Annual % change Total 1,043,378 1,078,007 1,073,751 1,066,616 1,100,875 1,151,269 1,173,248 1,155,885 1,153,579 1,163,568 1,187,606 24, % 144, % Total HCHS medical and dental staff 78,462 82,568 85,975 87,533 91,586 96,598 97,636 99, , , ,501 1, % 26, % Total HCHS non-medical staff 861, , , , , , , , , , ,789 20, % 95, % Total GPs 31,021 31,901 33,384 33,730 34,043 36,085 35,243 35,319 35,871 36,294 36, % 5, % Total GP Practice staff 6 72,006 72,990 76,977 75,085 73,292 72,153 82,802 84,609 85,546 87,144 88,396 1, % 16, % Professionally qualified clinical staff 535, , , , , , , , , , ,050 10, % 87, % All doctors 109, , , , , , , , , , ,421 2, % 31, % Consultants (including Directors of public health) 28,141 29,613 30,619 31,430 32,679 34,654 35,781 36,965 38,197 39,014 40,443 1, % 12, % Registrars 16,112 17,313 18,180 30,175 34,272 36,700 37,527 38,134 38,489 39,407 39, % 23, % Other doctors in training and equivalents 24,542 25,981 27,242 15,875 14,026 14,517 13,869 13,860 13,773 13,991 13, % -10, % Hospital practitioners and clinical assistants (non-dental specialties) 1, % % Other medical and dental staff 8,596 8,750 9,178 9,394 9,797 10,031 9,949 10,034 10,091 9,932 10, % 1, % GPs total 1,2 31,021 31,901 33,384 33,730 34,043 36,085 35,243 35,319 35,871 36,294 36, % 5, % GPs (excluding retainers and registrars) 28,308 29,248 30,931 30,936 30,675 32,111 31,356 31,391 31,578 32,075 32, % 4, % GP Providers 26,179 26,629 26,360 25,813 25,390 25,378 24,394 24,415 24,095 24,043 23, % -2, % Other GPs 2,129 2,619 4,571 5,123 5,285 6,733 6,962 6,976 7,483 8,032 8, % 6, % GP registrars 5,7 2,454 2,435 2,190 2,409 3,055 3,659 3,718 3,784 4,138 4,093 4, % 1, % GP retainers % % Total qualified nursing staff 300, , , , , , , , , , ,577 5, % 28, % Qualified nursing, midwifery & health visiting staff 286, , , , , , , , , , ,514 5, % 26, % GP practice nurses 6 13,563 13,793 14,616 14,554 13,962 13,582 14,644 14,797 14,695 14,943 15, % 1, % Total qualified scientific, therapeutic & technical staff 8 108, , , , , , , , , , ,352 1, % 26, % Qualified Allied Health Professions 53,311 55,133 55,711 57,065 59,455 61,865 62,801 62,937 63,198 64,377 66,090 1, % 12, % Qualified Healthcare Scientists 25,960 27,527 28,004 27,756 28,445 29,571 29,507 29,061 28,760 27,287 25,273-2, % % Other qualified scientific, therapeutic & technical staff 29,314 30,555 30,777 32,286 34,060 36,687 39,003 39,743 40,911 41,802 43,989 2, % 14, % Qualified ambulance staff 4 16,587 17,417 15,723 16,535 16,889 17,214 17,686 17,855 17,755 17,815 17, % 1, % Support to clinical staff 271, , , , , , , , , , ,555 11, % 35, % Support to doctors & nursing staff 218, , , , , , , , , , ,666 7, % 20, % Support to scientific, therapeutic & technical staff 44,089 44,708 43,906 43,113 45,630 49,337 52,175 51,763 51,299 51,454 54,261 2, % 10, % Support to ambulance staff 8,653 9,066 11,209 10,225 11,882 13,088 13,440 12,970 12,282 12,895 13, % 4, % NHS infrastructure support 178, , , , , , , , , , ,486 1, % 6, % Central functions 85,498 90,387 87,856 86,772 92, , ,393 96,842 95,017 93,177 95,495 2, % 9, % Hotel, property & estates 56,593 58,201 54,975 55,131 57,135 58,211 58,090 56,344 55,541 55,267 53,827-1, % -2, % Manager & senior manager 36,007 37,549 35,041 34,955 37,937 42,509 40,094 36,613 35,650 34,588 35, % % Other non-medical staff or those with unknown classification % % Other GP practice staff 6 58,443 59,197 62,361 60,531 59,330 58,572 68,158 69,812 70,851 72,201 73,334 1, % 14, % Notes: 1 GP full time equivalent (FTE) data for 2004 and 2005 has been estimated using the results from the GMP Workload Survey. 2 From 2006 onwards GP FTE has been collected and therefore may not be fully comparable with previous years. 3 Nursing and midwifery figures exclude students on training courses leading to a first qualification as a nurse or midwife. 4 In 2006 ambulance staff were collected under new, more detailed, occupation codes. As a result, qualified totals and support to ambulance staff totals are not directly comparable with previous years. 5 GP Registrar count from 2008 onwards represents an improvement in data collection processes and comparisons with previous years should be treated with caution 6 Practice staff figures for 2010 & 2011 were revised in Further details can be found in the data quality statement/methodology. This will affect any related totals and comparisons with years prior to From 2012 GP Registrars have been removed from the GP Workforce collection where a duplicate record already exists on the Electronic Staff Record. Due to a change in coding practices in some regions GP Registrars are increasingly recorded on the ESR system rather than the GP Exeter Payment System. All these staff are not shown in the GP Registrar totals but are included in the HCHS Medical and Dental Registrars total 8 A reclassification of healthcare scientists in 2013/14 has led to a shift in numbers within qualified scientific, therapeutic and technical staff, this affects 2014 data. These statistics relate to the contracted positions within English NHS organisations and may include those where the person assigned to the position is temporarily absent, for example on maternity leave. Full Time Equivalent (FTE) refers to the proportion of each role s full time contracted hours that the post holder is contracted to work. 1 would indicate they work a full set of hours, 0.5 that they worked half time. From 2011 the bank staff return was suspended (and formally ceased in 2013). All data (for all years) in these tables excludes bank staff From April 2013 Public Health England was excluded from workforce publications. Copyright 2015 Health and Social Care Information Centre. All rights reserved