Abstract
SummaryBackgroundPrimary care is the main source of health care in many health systems, including the UK National Health Service (NHS), but few objective data exist for the volume and nature of primary care activity. With rising concerns that NHS primary care workload has increased substantially, we aimed to assess the direct clinical workload of general practitioners (GPs) and practice nurses in primary care in the UK.MethodsWe did a retrospective analysis of GP and nurse consultations of non-temporary patients registered at 398 English general practices between April, 2007, and March, 2014. We used data from electronic health records routinely entered in the Clinical Practice Research Datalink, and linked CPRD data to national datasets. Trends in age-standardised and sex-standardised consultation rates were modelled with joinpoint regression analysis.FindingsThe dataset comprised 101 818 352 consultations and 20 626 297 person-years of observation. The crude annual consultation rate per person increased by 10·51%, from 4·67 in 2007–08, to 5·16 in 2013–14. Consultation rates were highest in infants (age 0–4 years) and elderly people (≥85 years), and were higher for female patients than for male patients of all ages. The greatest increases in age-standardised and sex-standardised rates were in GPs, with a rise of 12·36% per 10 000 person-years, compared with 0·9% for practice nurses. GP telephone consultation rates doubled, compared with a 5·20% rise in surgery consultations, which accounted for 90% of all consultations. The mean duration of GP surgery consultations increased by 6·7%, from 8·65 min (95% CI 8·64–8·65) to 9·22 min (9·22–9·23), and overall workload increased by 16%.InterpretationOur 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. Notably, our data only explore direct clinical workload and not indirect activities and professional duties, which have probably also increased. This and additional research questions, including the outcomes of workload changes on other sectors of health care, need urgent answers for primary care provision internationally.FundingDepartment of Health Policy Research Programme.
Highlights
Interpretation Our findings show a substantial increase in practice consultation rates, average consultation duration, and total patient-facing clinical workload in English general practice
Primary care is central to the provision of health care in many developed health systems, including the National Health Service (NHS), providing most first-contact health care; disease diagnosis, monitoring, and management; and disease prevention, through screening and health promotion
Study design and population We did this retrospective analysis of general practitioners (GPs) and nurse consultations of non-temporary patients registered at 398 English general practices between April, 2007, and March, 2014
Summary
Primary care is central to the provision of health care in many developed health systems, including the National Health Service (NHS), providing most first-contact health care; disease diagnosis, monitoring, and management; and disease prevention, through screening and health promotion. Primary care is the gatekeeper to secondary care in hospital, and can provide sickness certification access to benefits. Despite this high volume of health-care activity internationally (about 90% of all NHS contacts occur in primary care), remarkably few data are available for the volume and nature of primary care activity from any country. Most estimates of primary care workload are from the UK, but are either very old,[1] only provide crude consultation rates (up to 2009),[2] or are based on survey recall.[3] In the past few years, concerns have increased, especially in the UK, that primary care is overwhelmed by unsustainable workload increases, with pressures on emergency departments reported as due to reduced access to general practice. The 2015 general practitioner (GP) worklife satisfaction survey showed the lowest overall job satisfaction since the surveys started in 2001.4 We did this study to obtain accurate data for the volume and nature of primary care workload
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