Assessing workload in general practice in England before and after the introduction of the pay-for-performance contract

Source: Islay Gemmell, Stephen Campbell, Mark Hann, Bonnie Sibbald, Journal of Advanced Nursing, Volume 65 Issue 3, March 2009
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From the abstract:
In 2004, a new pay-for-performance contract for general practice was introduced in England. This improved the quality but may also have altered practice workload, including the workload of nursing staff.

The number of practice staff increased with greater increases observed for nursing staff than doctors. There was no change in the average number of hours worked per week by nursing staff or doctors but nurse visit rates increased while doctors’ rates decreased. The proportion of presenting problems described as chronic or preventative increased for doctors but was unchanged for nursing staff. Nursing staff dealt with more complex visits in 2005 compared to 2003 but there was no change for doctors.

General practices may have responded to the 2004 contract by increasing staffing levels, with nursing staff absorbing a higher proportion of the clinical workload and doctors focusing more attention on chronic and preventive care. Expanding nursing staff roles may increase the quality of primary care but may lead also to intensification of nurses’ work.

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