Could a New Model for Assessing GP Performance and Resourcing Transform Healthcare in the Uk?

As the British Medical Association (BMA)[i] warns of the worst winter on record for the NHS, a pioneering project by More Metrics, in collaboration with Lancaster University, may provide answers to the growing crisis in GP practices. With surgeries struggling with patient backlogs and a severe shortage of doctors, More Metrics’ innovative approach to assessing GP performance and resourcing could reshape healthcare in the UK and significantly improve patient outcomes.

The BMA’s “Weathering the Storm” report stresses an urgent need for action, highlighting rising demand and limited resources facing GP practices. More Metrics, a specialist in open-source data analysis on family finances, health, and social issues, has undertaken a project to address a critical question: How does the level of GP resourcing impact health outcomes?

Introducing the GP Performance Grid

More Metrics typically works with insurers and charities, to better understand mortality and disease risks. Recognising the broader societal implications of their work, the company sought to deepen its analysis by partnering with Lancaster University to explore GP performance in more depth.

This led to the creation of the GP Performance Grid, a tool that evaluates GP practices using data including patient satisfaction scores, health outcomes, disease diagnosis rates and mortality risk. More Metrics created a GP Performance Grid, a framework to establish minimum resourcing standards for GP surgeries. By addressing disparities in resourcing, this framework could be a game changer in improving health outcomes for patients. In parallel, two MSc students at Lancaster University have been investigating specific aspects of GP performance to provide additional insights.

Data collection and analysis

The analysis covered 5,900 GP practices in England, using publicly available data from the NHS, the Office for National Statistics (ONS), and other open sources. Key data points included GP workforce statistics, disease prevalence, funding calculations, mortality rates, and patient satisfaction scores. More Metrics also used Care Quality Commission (CQC) ratings to check the accuracy and relevance of the data used in their modelling.

This data provided the foundation for exploring the link between GP resourcing levels and health outcomes. International studies have shown a strong correlation between the number of doctors and life expectancy. More Metrics aimed to determine whether a similar relationship exists at a more localised level, where factors like social deprivation and the availability of resources could have a significant impact on health outcomes. The challenge was not straightforward.

The complexity of resourcing and health outcomes

The relationship between GP resourcing and health outcomes is complex, and almost always confounded by levels of deprivation. To address this More Metrics used exploratory data analysis to work out how they might “unpick” these two effects before embarking on more detailed work. Their approach involved several stages: gathering data, analysing GP resourcing levels, statistical modelling of excess deaths, and using the Performance Grid to present findings. This process enabled the team to propose an appropriate minimum GP-to-patient resourcing level for UK practices.

The correlation between GP resources and excess deaths The Performance Grid provided a way to separate ‘resourcing’ from ‘excess deaths,’ allowing a clearer view of how practices compare. While there is some correlation between resourcing and mortality, outcomes are also influenced by GP performance.

While two GP surgeries may have identical resourcing levels, one may have experienced doctors and a very efficient support team and another less experienced staff and poor processes. It is likely patient health outcomes will be poorer in the second practice, with shorter life expectancy and excess deaths.

To isolate factors unrelated to resourcing, More Metrics analysed disease diagnosis patterns, adjusted for age, sex, and neighbourhood health, against excess deaths as a proxy for GP efficiency. Using a grid structure, they demonstrated it is possible to provide a GP performance assessment that separates out the two key drivers.

Trainees make up 25% of the available GP resources. However, trainees are often placed in practices with already high GP ratios, probably because training can only be delivered where there is spare capacity amongst qualified doctors to provide training.

However, this situation exaggerates resourcing differences. Moreover, recent press reports[ii] indicate GPs who completed training struggle to find a permanent position, suggesting they maybe surplus to requirements in practices where they are trained and are not deployed where they are most needed once qualified.

Smaller practices with older doctors tend to have lower GP ratios, likely due to challenges in transitioning toward retirement while maintaining patient care. Time-series data indicates GP resourcing levels change slowly, highlighting the difficulty of corrective action by the NHS, especially since most practices are contracted independently.

A surprising finding was the range in GP to patient ratio across the English network. The average GP to patient ratio is three times higher in the top quarter of practices compared to the bottom. This difference is not related to the funding formula used for setting budgets. The calculation of GP ratio used in the study means if practices were resourced consistently to the funding formula there would be no variation in the GP ratio.

Implications for policy and practice

More Metrics’ findings have profound implications for GP resourcing management in England. Disparities directly impact health outcomes, including excess deaths. Addressing these gaps requires active resourcing management by Integrated Care Boards (ICBs), which can redistribute resources to where they are needed most.

This data-driven approach could identify inefficiencies, reduce health inequalities, and improve patient outcomes. Establishing minimum GP resourcing standards could help resolve the GP crisis.

Looking ahead - a collaborative effort for change

In 2025, More Metrics plans to share its datasets with researchers at Lancaster University and other institutions to provide greater insights and academic rigour.

Discussing the collaboration, Chris Kirkbride, Senior Lecturer in Management Sciences at Lancaster University said, “More Metrics’ deep dive into the wealth of public data made available by the NHS,to start the challenging work of understanding the relationship of resourcing in GP surgeries to patient outcomes, had already developed valuable insights and generated more questions that could help us interpret GP resourcing better.

When I became involved, the idea was to provide an opportunity for two MSc Business Analytics students to work directly with More Metrics to provide a fresh look at the data. The idea was for a broad exploratory data analysis that would look in more detail at how different GP resourcing decisions relate to various performance outcomes available from the data.

In addition to the project’s value, students gained an insight into the transition between cleaner academic problems to the messier OR problems practitioners deal with. With More Metrics’ OR expertise and encouragement, students were given freedom to explore interesting avenues and bring in alternative data to develop new insights. The project contributed to More Metrics’ analysis and raised new questions and opportunities for new MSc students to investigate further.”

By collaborating with universities that have access to non-public data, More Metrics hopes to pave the way for actionable solutions to reshape GP care in the UK. The urgency for transformation in GP resourcing cannot be overstated. More Metrics’ innovative work, supported by Lancaster University, provides evidence to drive change, ensuring equitable, effective patient care both now and in the future.

[i] https://www.bma.org.uk/advice-and-support/nhs-deliveryand-workforce/pressures/vital-actions-to-minimise-pressureon-the-nhs-this-winter
[ii] https://www.pulsetoday.co.uk/news/workforce/over-halfof-job-seeking-gps-are-struggling-to-find-role-finds-rcgp/workforce/over-halfof-job-seeking-gps-are-struggling-to-find-role-finds-rcgp/