‘Frequent attenders’ now make up around 4 in every 10 family doctor (GP) consultations in England, and the proportion of such patients has risen over the past two decades.
Frequent attenders visit their GP five times as often as other patients on a general practice list, helping to explain the perceived rise in GP workload, reveals the analysis of nearly 1.7 billion consultations over 20 years.
GPs in the UK have repeatedly sounded the alarm on the rapid increases in their workload in recent years, prompted by an ageing population, the complexity of care needs, and initiatives to shift care from hospitals into the community.
But there’s been little published research on current workload rates in general practice in the UK, particularly the contribution made by ‘frequent attenders.’
Preliminary data suggest that the top 10% of attenders could be responsible for between 30% and 50% of all GP consultations.
To explore this further, the researchers set out to analyse the type and distribution of consultations within general practices and practice lists, focusing on frequent attenders, over a period of 20 years.
They drew on anonymised information on 1.7 billion consultations with 12.3 million patients, submitted to the Clinical Practice Research Database by 845 GP practices across the UK between April 2000 and March 2019. Only 113 practices contributed data throughout the entire study period.
They looked at consulting patterns among the top 10% of consulting patients with: all staff, including admin staff, in the practice; only with GPs, to include face to face, remote, and phone consultations; as well as face to face consultations with all staff, and only with GPs.
All types of consultations with all staff in a practice more than doubled, rising from an annual average of 11 per person in 2000–01 to 25 in 2018–19; for GPs the equivalent figures were an annual average of 5 in 2000-01 to 8 per person in 2015-18.
Among frequent attenders, all types of consultations with GPs rose from an average of 13 to 21 a year while those with other practice staff rose from an average of 27 a year to 60 between April 2000 and March 2019.
In all, around four out of 10 consultations of any type concerned frequent attenders, and the proportion of consultations attributed to them increased over time, particularly for face to face consultations, rates of which fell among other patients.
The proportion of face to face consultations with GPs among frequent attenders rose from an average of 38% in 2000–01 to 43% in 2018–19, and from an average of 38% to 40% for all practice staff.
Frequent attenders consulted around five times more often than the rest of the practice list, on average.
There was relatively little regional variation in any of the trends studied, the only exceptions being face to face consultations with GPs, which were highest in Scotland and face to face consultations with all staff, which were highest in Northern Ireland.
And frequent attendance rates didn’t seem to be influenced either by area levels of deprivation or the practice. But evidence from Europe indicates that frequent attenders are more likely to be female, older, have more social and psychiatric problems, taking more drugs for mental illness, have more medically unexplained symptoms, and more long term conditions, note the researchers.
This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. And the researchers acknowledge that they used their own definition of frequent attenders.
But the findings echo those of Dutch studies, they say, and suggest “that a relatively small number of patients are accounting for a large proportion of GP workload including face-to-face consultations.”
They conclude: “Frequent attenders appear to be a major driver for the increase in consultations that have contributed to perceptions of increased workload in general practice.
“GPs should be looking at this group of patients more closely to understand who they are and why they are consulting more frequently.”
The findings of this large long term study is published in the open access journal BMJ Open.
