Primary care ‘could be reaching saturation point’ due to upward trend in consultation rates
June 8 2016
Primary care consultation rates increased by more than 10% on average in just seven years in England, with GPs seeing the greatest increase.
The crude annual consultation rate per person has increased from 4.67 in 2007-08 to 5.16 in 2013-14, up 10.51%. GP consultations increased 13.67% , with a rise of 12·36% per 10 000 person-years in age-standardised and sex-standardised rates. This compares with 0·9% for practice nurses.
In addition, GP telephone consultation rates also doubled, while surgery consultations (accounting for 90% of all consultations) increased by 5·20%. Duration of GP surgery consultations also lengthened, with a mean increase from 8.65 minutes to 9.22 minutes, up 6.7%. Overall workload increased by 16%, a Lancet study has reported.
The figures have been identified in a retrospective analysis of patient consultation data from 398 GP practices in England, over the period April 2007 to March 2015. The researchers from the Nuffield Department of Primary Care Health Sciences in the Radcliffe Observatory Quarter, Oxford, included data from 101.8 million consultations equivalent to 20.6 million person-years of observation.
Interpreting the figures, the team said: “Our findings show a substantial increase in practice consultation rates, average consultation duration, and total patient-facing clinical workload in English general practice. These results suggest that English primary care as currently delivered could be reaching saturation point.”
They also point out that the figures relate only to direct clinical workload and not indirect activities and professional duties, “which have probably also increased.” The evidence indicates that “one response to coping with this increased workload—use of telephone triage—is accelerating rapidly (doubled in the seven years), despite findings showing that this strategy does not reduce overall primary care workload, only appeals to a subset of the population, and might reduce the proportion of primary care devoted to preventive activities.”
The study found that for practice nurses, consultation rates had risen slightly and then decreased slightly, although neither change was statistically significant. While face-to face consultations had remained stable, telephone consultation rates had dropped slightly, again not significantly, but nurse home-visit rates had decreased by 6.5% a year over the first five years of the study period.
An editorial commenting on the study notes that the overall workload of GPs rose by 16% over the seven year period, with more frequent and longer GP consultations. “These startling results reflect what we and many of our GP colleagues have experienced—a seemingly endless demand for consultations, coupled with more complex patient care, escalating administrative tasks, pressures to meet quality performance targets, and rising documentation requirements,” they commented.
“A worrying amount of this work happens not just within consultations, but also afterwards, which can account for an estimated additional eight hours of work per week or more for an average GP. This struggle to provide the quality of care GPs would like to offer in the face of competing demands on time, is contributing to alarming rates of burnout.”