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Thinking about skill mix in General Practice

Published: 11 August, 2020

A key component of the General Practice Forward View (GPFV) is investment in ‘new’ roles such as clinical pharmacists, physiotherapists, physician associates, and paramedics. An NIHR reserch project  (1) is investigating the scale, scope and impact of skill mix change in primary care since the GPFV. While the studies are ongoing they have published early findings in British Journal of General Practice.

One workstream (2) is examining what practice characteristics are associated with the current employment of these ‘new’ roles. Initial estimates suggest that the employment of ‘new’ roles has occurred in larger practices (in terms of list size), in practices with a higher proportion of patients living in deprived areas and practices with a larger proportion of patients aged >65 years.

An ongoing survey (3) of Practice Mangers is asking about their decision making around current and future skill mix in their practice. Early findings from 1000 practices include:

  • practices that have employed physician associates have done so to increase appointment availability (78% of practices) and release GP time (68%).
  • Sixty-six per cent of practices who have employed pharmacists have received some form of financial assistance with 21% of practices still receiving assistance.
  • When asked to construct an ideal workforce, ‘new’ roles accounted for 20% of that workforce on average, which is a significantly larger proportion than those roles currently account for.

(1) An investigation of the scale, scope and impact of skill mix change in primary care Spooner S et al, HS&DR – 17/08/25

(2) Determinants of primary care workforce variation in England. Jon Gibson, Sharon Spooner and Matt Sutton. British Journal of General Practice 2020; 70 (suppl 1): bjgp20X711389. DOI:

(3) Motivating factors behind skill mix change: results from a practice managers’ survey in England. Jon Gibson, Sharon Spooner, Matt Sutton, Imelda McDermott, Mhorag Goff, Kath Checkland, Damian Hodgson, Anne McBride and Mark Hann. British Journal of General Practice 2020; 70(suppl 1):bjgp20X711401. DOI:


Last updated: 7 August, 2020

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