Abstract
BackgroundPrimary care workload is high and increasing in the United Kingdom. We sought to examine the association between rates of primary care consultation and outcomes in England.MethodsCross sectional observational study of routine electronic health care records in 283 practices from the Clinical Practice Research Datalink from April 2013 to March 2014. Outcomes included mortality rate, hospital admission rate, Quality and Outcomes Framework (QOF) performance and patient satisfaction. Relationships between consultation rates (with a general practitioner (GP) or nurse) and outcomes were investigated using negative binomial and ordinal logistic regression models.ResultsRates of GP and nurse consultation (per patient person-year) were not associated with mortality or hospital admission rates: mortality incidence rate ratio (IRR) per unit change in GP/ nurse consultation rate = 1.01, 95% CI [0.98 to 1.04]/ 0.97, 95% CI [0.93 to 1.02]; hospital admission IRR per unit change in GP/ nurse consultation rate = 1.02, 95% CI [0.99 to 1.04]/ 0.98, 95% CI [0.94 to 1.032]. Higher rates of nurse but not GP consultation were associated with higher QOF achievement: OR = 1.91, 95% CI [1.39 to 2.62] per unit change in nurse consultation rate vs. OR = 1.04, 95% CI [0.87 to 1.24] per unit change in GP consultation rate. The association between the rates of GP/ nurse consultations and patient satisfaction was mixed.ConclusionThere are few associations between primary care consultation rates and outcomes. Previously identified demographic and staffing factors, rather than practice workload, appear to have the strongest relationships with mortality, admissions, performance and satisfaction. Studies with more detailed patient-level data would be required to explore these findings further.
Highlights
Primary care workload is high and increasing in the United Kingdom
The distribution of practices in each decile of Quality and Outcomes Framework (QOF) performance and General Practice Patient Survey (GPPS) domain are given in the online supplement (Additional file 1: Table S3)
We have found that rates of general practitioner (GP) and nurse consultation are not associated with mortality or hospital admission rates at the practice level
Summary
We sought to examine the association between rates of primary care consultation and outcomes in England. Patients in practices which provide more consultations might be less likely to use hospital services, owing to the fact that they do not experience difficulties accessing primary care. An increased consultation rate might indicate inadequate clinical triage and excessive practice workload. This might lead to a reduction in quality of care, worse patient outcomes and greater use of secondary health care resources. Such potential relationships are important for health service planning but are poorly understood
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