NATIONAL PRIMARY CARE WORKFORCE SURVEY ADVISORY GROUP REPORT ON 2013 SURVEY - WEB ONLY

Recommendations For The Development of Future Surveys

41. Having requested feedback from those involved in completing the 2013 Survey and collated the comments received, the Advisory Group considered the most effective means by which to collect similar data in future years. The Advisory Group's main recommendations are set out below with subsequent pages detailing other recommendations.

Scope

In Hours

42. The enhancements made to the In Hours form since the 2009 Survey proved helpful but the feedback received indicates that there is still scope for refinement and consideration of the following issues:

• Evaluate with ISD Scotland, the advantages and disadvantages of targeting a representative sample of GP practices, rather than targeting 100% of practices.
• Include questions targeted at those practices which have opted-in to provide an OOH service to their own patients (this should be done in liaison with the Remote Practitioners' Association of Scotland).
• Request data on time spent in excess of sessional commitment undertaking related duties, such as administrative tasks.
• Request data on when GPs are working day shifts and OOH back to back.
• Request data on those GPs and nurses in Scotland who work on a locum basis: their age profile and the number of sessions they work in "In hours" General Practice.
• Request data on those clinical staff employed by Health Boards but placed in GP practices.

43. The Group recommends that the necessary time is allocated to considering these issues and the detailed recommendations set out on Detailed recommendations. The Group estimates that 6-9 months should be allowed for refining and piloting any enhancements agreed as a result of consideration of the issues at paragraph 42 in liaison with key primary care stakeholders.

Out of Hours

44. The 2009 Survey was in respect of In Hours service only but the 2013 Survey was expanded to request data on GP Out of Hours provision. The Group believes that the 2013 run of the OOH strand of the survey gathered some very useful information but recognises that more time is required to consult with the National OOH Operations Group members and Health Board workforce planners on matters including:

• Key questions to be raised in the Survey.
• Feasibility of OOH services providing robust and comparable data in response to Survey questions.
• Definitions for certain terms used in the Survey.
• Intended uses of the results.
• Actual use of the results of the 2013 Survey.

45. The Group recommends that the necessary time is allocated to liaison with the National Out of Hours Operations Group and Health Board workforce planners to consider these matters and the detailed recommendations set out on Out of Hours Form and Guidance. The Group estimates that 9-12 months would be required to develop and pilot a revised form following discussion and agreement with key stakeholders in respect of the issues outlined at paragraph 44. The Group also recommends that this work is planned on the basis of including both the In Hours and Out of Hours forms in the next and future Surveys.

Non clinical staff

46. The Group is aware that the Cabinet Secretary for Health and Wellbeing expressed an interest late last year in data relating to all staff employed by GP practices (clinical and non-clinical). Having been advised of the limited scope of the National Primary Care Workforce Survey, he requested that consideration be given, in liaison with the relevant stakeholders, to extending the scope of future Surveys.

47. The Group recognises that data on the full complement of staff employed by GP practices may be of interest to a range of parties, in addition to Scottish Ministers and those represented on the Advisory Group, for example, to the general public and media, thereby requiring access to reliable and current data. Included in the feedback submitted to the Advisory Group, was support for collection of data on Practice Managers as this would assist with vocational training, promote the role of the Practice Manager (a critical role within practices and not just one of the administrative staff) and ensure that ongoing good management would be available for any changes to practice processes that are necessary.

48. The Group recommends that the scope of the Survey is expanded to request data on non-clinical staff employed by GP practices. This would require consultation with those organisations represented on the Advisory Group and with GP Practice Managers.

49. Based on the experience of developing the 2013 OOH form, the Group estimates that 12 months would be required to develop and pilot the expanded forms, in liaison with the relevant stakeholders.

Frequency of future Surveys

50. Turning to frequency of future Surveys, the Group recognises that it can be a resource intensive exercise (in respect of completion) for some GP Practices and Health Boards and for Glasgow LMC and ISD Scotland (in respect of checking and collating). This, in turn, has implications for the overall cost of the exercise funded by the Scottish Government.

51. In order to minimise the burden but ensure that the data is reasonably current, the Group recommends that a National Primary Care Workforce Survey be undertaken every 2 years, with feedback provided to the primary care sector in the year between, about the previous year's Survey and how it has informed workforce planning. The Group also recommends that, if undertaken every 2 years, the Scottish Government should liaise with:

• ISD Scotland and primary care stakeholders to clarify the objectives of the Survey.
• ISD Scotland about making the process more efficient and cost-effective.
• ISD Scotland and SGPC about whether local systems/processes could be adapted to make it easier for GP practices to provide the required information in respect of In Hours' service.
• ISD Scotland and SGPC about whether the collection and collation stages of the Survey could be streamlined.
• ISD Scotland and Health Board workforce planners about whether local systems/processes could be adapted to make it easier for Boards to provide the required information in respect of the OOH service.
• Health Boards about supporting development of the Survey, as well as supporting its promotion, completion (by GP Practices and OOH Board leads) and use of its results locally thereafter.

Timing and Duration of Survey

52. Feedback received in respect of the 2013 Survey indicated that one of the reasons for a lower response rate than hoped for, was due to the time of year at which the Survey was undertaken. The 2013 timetable (31 January census date and 4 weeks in which to complete and returns forms) was based on the 2009 timetable. However, the last quarter of the financial year is a busy time for GP practices and OOH services. The Group recommends that future surveys are undertaken on the basis of a 31 August census date and 6 weeks are allowed for completion and return of the forms. This timescale will hopefully mitigate the pressures of summer holidays and avoid winter pressures.

Maximising Response Rate

53. As previously indicated, the target response rate for the 2013 In Hours forms was 67% and the overall response rate was 64%. Although the target was not quite reached, the Group recognises that 64% is a healthy response rate for a non-routine, electronic national survey.

54. As indicated at para 52 above, the timing of the Survey may have contributed to the target response rate not being reached. Another factor with some practices was the lack of financial support. Although the economic climate may not always support a financial outlay to GP practices to encourage the completion and return of Survey forms, the Group recommends that, in discussing how to maximise response rate when planning future Surveys, the options considered include the viability of the provision of financial support in recognition of the resources required to complete it as effectively as possible.

55. Feedback received indicates that awareness of the Survey across the range of clinical staff in GP practices, including those who would perhaps have been able to provide data for the purposes of completing the form, was patchy. On distribution, the Survey was deliberately not addressed to any one individual or position within a GP practice but the covering e-mail invited it to be passed to the person most likely to be able to complete the form. The Group recognises that no one person within a GP practice may have access to reliable data in respect of each element of the form. The Group recommends that the guidance which accompanies the In Hours form includes advice on those within the GP practice who may be able to provide which elements of the data requested, such as Practice Nurses for the nursing questions.

56. Promotion before, during and after launch of the Survey is also key to maximising the response rate. These promotional messages should make clear:

• The purpose of the Survey.
• The data required and the timescale for completion.
• The help available for the purposes of completing the form.
• The availability of the data collected on conclusion of the Survey.
• How this data will be used by key stakeholders.
• How the results of previous Surveys have been used to inform workforce planning e.g. training numbers/educational developments.
• The value to individual responders of completing the form, including any support offered.
• How to get more information.

57. Once the Survey has concluded, communication should continue with stakeholders, in order to:

• Thank them for their assistance in promoting awareness of the Survey.
• Thank respondents for completing and returning the forms.
• Keep respondents updated in respect of availability/publication date of the data.
• Provide a reminder of how the data will be used.
• Explain any gaps and why filling them in future iterations of the Survey would help.
• How to get more information.

58. The Group recommends that these messages are circulated as widely as possible, using networks and representative bodies to forward the messages to members and interested parties, raising awareness of the Survey and the short and long term benefits to the primary care sector of availability of accurate and robust data. In addition, the Group recommends circulation of a reminder 3 weeks into the 6 weeks of the Survey period. This reminder should include the Survey forms and guidance to aid access to, and completion of, the relevant documentation.

Detailed recommendations

59. The following 2 pages set out a number of detailed recommendations in respect of the development and content of future In Hours and Out of Hours Survey forms and guidance.

In Hours Form and Guidance

• GPN nurse leads, RCN, SPNA and Practice Managers should be involved in reviewing the questions.
• Include a definition of "OOH" (clarifying the difference between extended hours and out of hours and refining the categories of activities).
• Include definitions of "full time" and "session".
• Request data on the time spent in the GP practice and time spent on other sessional commitments.
• Separate into bank, agency and additional hours worked by existing staff.
• Further separate out questions in respect of nursing roles. In particular, request data on additional/extended hours worked by each nursing designation: advanced nurse practitioner; general practice nurse/treatment room nurse; health care support worker; phlebotomist.
• Include a Yes/No option response with appropriate questions.
• In the case of HCAs/phlebotomists, make it clear in the guidance that only the hours that relate directly to HCA/phlebotomy duties and any administrative duties directly related to these clinical duties, should be recorded.
• Review and enhance instructions to indicate which fields must include a value, even if that value is zero.
• Issue guidance note as separate file to Survey form, stressing the importance of the guidance being read, even if those completing the forms are familiar with previous versions.

Out of Hours Form and Guidance

• The National OOH Operations Group, Health Board workforce planners, RCN Scotland and Health Board Nurse OOH leads should be involved in reviewing all questions.
• Split agency/locum into two separate designations and include definitions of both designations.
• Include separate response options for both advanced nurse practitioner and registered nurse for each question.
• Split "other clinical staff" into range of individual designations, including paramedic practitioners, and include definition of each designation.
• Request data on nurses not solely employed/managed by GP OOH services.
• Review and enhance instructions to indicate which fields must include a value, even if that value is zero.