General Practice is central to the NHS, and is where people first seek non-emergency health advice. GPs deal with a wide range of health and social care issues for local people. They have traditionally employed a staff team of e.g. nurses, care assistants, receptionists, managers and liaise with community services such as midwives and health visitors. Many GPs are retiring or leaving the NHS. More newly-trained doctors work in hospitals and there is a shortage of GP practice nurses. NHS general practice is under pressure. At the same time, more people with long-term conditions need regular care from GP teams. Tasks formerly done in hospital are being transferred to general practice. It is vital that GPs organise teams efficiently to treat as many patients as possible. General Practices’ staffing arrangements vary widely. Practices have tended to become larger over time, and include a wider range of staff (e.g. physiotherapists, pharmacists). Some GPs have combined into ‘super-practices’. There is little evidence to show GPs and service commissioners what size or structure of practice, or professional staff mix, works best for patients. This NIHR Health Services & Delivery Research-funded project aims to provide such evidence, exploring how the composition of GP teams and team relationships (‘climate’) affects quality of care and health outcomes for patients, and practice costs. Professor Stephen Peckham leads the project team, who will: Survey the literature to learn about skill mix in countries with healthcare systems resembling our NHS. Analyse existing big data sets and use statistical methods to investigate the relationship between differences in the organisation and skill mix of practices in England and quality of care and effectiveness. Quality measures will be based on inspection data. Effectiveness will be measured using number of patients hospitalised for conditions that should be general practice managed. Conduct a staff survey in a nationwide sample of practices to explore how workforce issues affect staff wellbeing and job satisfaction Observe/interview staff to investigate how team climate affects daily working and patient experience. Work with GPs and commissioners to review project findings and create guidelines for all practices on optimum professional staff mix and good team working. Find novel ways to publicise research results to GPs, NHS managers, government organisations, academics and the public. Patient and public opinion provided valuable input to the research application and a service user group will contribute at all stages of the project. Start date: 01/10/2018 End date: 30/09/21 Funder: NIHR Funding: £404,316