The Primary Care Workforce: The Author Replies

2014 ◽  
Vol 33 (1) ◽  
pp. 182-182
Author(s):  
Arthur L. Kellermann
Keyword(s):  
Primary Care ◽  
Primary Care Workforce

scholarly journals ECHO-Chicago Geriatrics: using telementoring to “geriatricize” the primary care workforce

2019 ◽  
Vol 41 (3) ◽  
pp. 333-341 ◽  
Author(s):  
Pari Jafari ◽  
Tia Kostas ◽  
Stacie Levine ◽  
Michelle Martinchek ◽  
Daniel Johnson ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Workforce

scholarly journals Cost impact of high staff turnover on primary care in remote Australia

2019 ◽  
Vol 43 (6) ◽  
pp. 689 ◽  
Author(s):  
Yuejen Zhao ◽  
Deborah J. Russell ◽  
Steven Guthridge ◽  
Mark Ramjan ◽  
Michael P. Jones ◽  
...  
Keyword(s):  
Primary Care ◽  
Staff Turnover ◽  
Remote Communities ◽  
Nurse Turnover ◽  
Department Of Health ◽  
High Staff Turnover ◽  
Cost Impact ◽  
Primary Care Workforce ◽  
Care Consultation ◽  
The Cost

Objectives The aim of this study was to estimate the costs of providing primary care and quantify the cost impact of high staff turnover in Northern Territory (NT) remote communities. Methods This cost impact assessment used administrative data from NT Department of Health datasets, including the government accounting system and personnel information and payroll systems between 2004 and 2015, and the primary care information system from 2007 to 2015. Data related to 54 government-managed clinics providing primary care for approximately 27200 Aboriginal and non-Aboriginal people. Main outcome measures were average costs per consultation and per capita, cost differentials by clinic, year and levels of staff turnover. Linear regression and dominance analysis were used to assess the effect of staff turnover on primary care costs, after adjusting for remoteness and weighting analysis by service population. Both current and constant prices were used. Results On average, in constant prices, there was a nearly 10% annual increase in remote clinic expenditure between 2004 and 2015 and an almost 15% annual increase in consultation numbers since 2007. In real terms, the average costs per consultation decreased markedly from A$273 in 2007 to A$197 in 2015, a figure still well above the Medicare bulk-billing rate. The cost differentials between clinics were proportional to staff turnover and remoteness (both P<0.001). A 10% higher annual turnover rate pertains to an A$6.12 increase in costs per consultation. Conclusions High staff turnover exacerbates the already high costs of providing primary care in remote areas, costing approximately A$50 extra per consultation. This equates to an extra A$400000 per clinic per year on average, or A$21million annually for the NT government. Over time, sustained investments in developing a more stable primary care workforce should not only improve primary care in remote areas, but also reduce the costs of excessive turnover and overall service delivery costs. What is known about the topic? Population size and geographical remoteness are important cost drivers in remote clinics, whereas elsewhere in Australia the high use of short-term staff to fill positions has been identified as a major contributor to higher nurse turnover costs and to overall health service costs. Nursing staff expenditure accounts for a large proportion (46%) of total expenditure in NT remote health services, whereas expenditure on Aboriginal Health Practitioners (AHPs) comprises only 6%. Annual nurse turnover rates in remote NT clinics average approximately 150%, whereas levels of 40% in other contexts are considered high. What does this paper add? Annual expenditure for NT remote clinics has increased, on average, by 10% per annum between 2004 and 2015, but small declines in real expenditure have been observed from a maximum in 2012. Expenditure on nursing staff comprises 40% of overall expenditure in remote clinics, whereas expenditure on AHPs comprises less than 5%. The cost impact of every 10% increase in remote nurse and AHP annual turnover has been quantified as an extra A$6.12 per primary care consultation, which equates, on average, to an extra A$400000 per remote clinic, and an extra A$21million overall for the NT Department of Health each year. The average real expenditure per primary care consultation has decreased from A$273 in 2007 to A$197 in 2015, representing a statistically significant linear trend reduction of A$7.71 per consultation annually. What are the implications for practitioners (and other decision-makers)? Adjusting policy settings away from the high use of short-term staff to investment in appropriate training ‘pipelines’ for the remote primary care workforce may, in the medium and longer term, result in reduced turnover of resident staff and associated cost savings. Targeted recruitment and retention strategies that ensure individual primary care workers are an optimal fit with the remote communities in which they work, together with improved professional and personal support for staff residing in remote communities, may also help reduce turnover, improve workforce stability and lead to stronger therapeutic relationships and better health outcomes.

scholarly journals Acceptability of physician associate interns in primary care: results from a service evaluation

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Elizabeth Cottrell ◽  
Victoria Silverwood ◽  
Alex Strivens-Joyce ◽  
Lucy Minshull ◽  
John J. Edwards ◽  
...  
Keyword(s):  
Primary Care ◽  
Analysis Data ◽  
Service Evaluation ◽  
Full Potential ◽  
Patient Acceptability ◽  
Practice Characteristics ◽  
Primary Care Workforce ◽  
Data Collection And Analysis ◽  
Or Practice ◽  
Five Practices

Abstract Background Physician associates (PA) form part of the policy-driven response to increased primary care demand and a general practitioner (GP) recruitment and retention crisis. However, they are novel to the primary care workforce and have limitations, for example, they cannot prescribe. The novel 1 year Staffordshire PA Internship (SPAI) scheme, introduced in 2017, was established to support the integration of PAs into primary care. PA interns concurrently worked in primary and secondary care posts, with protected weekly primary care focussed education sessions. This evaluation established the acceptability of PA interns within primary care. Methods All ten PAs from the first two SPAI cohorts, the nine host practices (supervising GPs and practice managers) and host practice patients were invited to participate in the evaluation. A conceptual framework for implementing interventions in primary care informed data collection and analysis. Data were gathered at three time points over the internship from practices, through discussions with the supervising GP and/or practice manager, and from the PAs via discussion groups. To enrich discussion data, PA and practices were sent brief surveys requesting information on PA/practice characteristics and PA primary care roles. Patient acceptability data were collected by the host practices. Participation at every stage was optional. Results By evaluation end, eight PAs had completed the internship. Seven PAs and six practices provided data at every time point. Five practices provided patient acceptability data. Overall PA interns were acceptable to practices and patients, however ambiguity about the PA role and how best to communicate and operationalise PA roles was revealed. An expectation-preparedness gap resulted in PAs needing high levels of supervision early within the internship. SPAI facilitated closure of the expectation-preparedness gap and its funding arrangements made the high supervision requirements more acceptable to practices. Conclusions The test-of-concept SPAI successfully integrated new PAs into primary care. However, the identified challenges risk undermining PAs roles in primary care before they have attained their full potential. Nationally, workforce leaders should develop approaches to support new PAs into primary care, including commitments to longer-term, sustainable, cohesive and appropriately funded schemes, including structured and standardised education and supervision.

Primary Care Technicians: A Solution To The Primary Care Workforce Gap

2013 ◽  
Vol 32 (11) ◽  
pp. 1893-1898 ◽  
Author(s):  
Arthur L. Kellermann ◽  
John W. Saultz ◽  
Ateev Mehrotra ◽  
Spencer S. Jones ◽  
Siddartha Dalal
Keyword(s):  
Primary Care ◽  
Primary Care Workforce

scholarly journals Primary care workforce and continuous medical education in China: lessons to learn from a nationwide cross-sectional survey

BMJ Open ◽  
2017 ◽  
Vol 7 (7) ◽  
pp. e015145 ◽  
Author(s):  
William C W Wong ◽  
ShanZhu Zhu ◽  
Jason J Ong ◽  
MingHui Peng ◽  
Cindy L K Lam ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Education ◽  
Continuous Medical Education ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Primary Care Workforce ◽  
Education In China

scholarly journals Not just another primary care workforce crisis …

2012 ◽  
Vol 62 (597) ◽  
pp. 178-179 ◽  
Author(s):  
Bill Irish ◽  
Mark Purvis
Keyword(s):  
Primary Care ◽  
Primary Care Workforce

scholarly journals Contribution of paramedics in primary and urgent care: a systematic review

2020 ◽  
Vol 70 (695) ◽  
pp. e421-e426 ◽  
Author(s):  
Georgette Eaton ◽  
Geoff Wong ◽  
Veronika Williams ◽  
Nia Roberts ◽  
Kamal R Mahtani
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Patient Satisfaction ◽  
Clinical Work ◽  
Ambulance Service ◽  
Urgent Care ◽  
Free Text ◽  
Clinical Role ◽  
Primary Care Workforce ◽  
The Uk

BackgroundWithin the UK, there are now opportunities for paramedics to work across a variety of healthcare settings away from their traditional ambulance service employer, with many opting to move into primary care.AimTo provide an overview of the types of clinical roles paramedics are undertaking in primary and urgent care settings within the UK.Design and settingA systematic review.MethodSearches were conducted of MEDLINE, CINAHL, Embase, the National Institute for Health and Care Excellence, the Journal of Paramedic Practice, and the Cochrane Database from January 2004 to March 2019 for papers detailing the role, scope of practice, clinician and patient satisfaction, and costs of paramedics in primary and urgent care settings. Free-text keywords and subject headings focused on two key concepts: paramedic and general practice/primary care.ResultsIn total, 6765 references were screened by title and/or abstract. After full-text review, 24 studies were included. Key findings focused on the description of the clinical role, the clinical work environment, the contribution of paramedics to the primary care workforce, the clinical activities they undertook, patient satisfaction, and education and training for paramedics moving from the ambulance service into primary care.ConclusionCurrent published research identifies that the role of the paramedic working in primary and urgent care is being advocated and implemented across the UK; however, there is insufficient detail regarding the clinical contribution of paramedics in these clinical settings. More research needs to be done to determine how, why, and in what context paramedics are now working in primary and urgent care, and what their overall contribution is to the primary care workforce.

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