The effect of workload on primary care doctors on referral rates and prescription patterns: evidence from English NHS

Hanifa Pilvar () and Toby Watt
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Hanifa Pilvar: University of Oxford
Toby Watt: The Health Foundation

The European Journal of Health Economics, 2025, vol. 26, issue 5, No 9, 817-837

Abstract: Abstract This paper investigates the impact of workload pressure on primary care outcomes using a unique dataset from English general practices. Leveraging the absence of General Practitioner (GP) colleagues as an instrumental variable, we find that increased workload leads to an increase in prescription rates of antibiotics as well as in the share of assessment referrals. On the other hand, the quantity and frequency of psychotropics decreases. When there is an absence, workload is intensified mostly on GP partners, and the mode of consultation shifts toward remote interactions as a response to higher workload pressure. The effects are more pronounced for patients above 65 years-old and those in Short-staffed practices. Our study sheds light on the intricate relationship between workload pressure and patient care decisions in primary care settings.

Keywords: Primary care workforce; Physicians’ workload; Referral decisions; Prescription patterns; Antibiotics; General practitioner (search for similar items in EconPapers)
JEL-codes: I10 I11 J81 (search for similar items in EconPapers)
Date: 2025
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DOI: 10.1007/s10198-024-01742-7

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