To what extent has GP workload increased?

How does the data match your own day-to- day experience in practice?

Few objective data exist for the volume and nature of primary care activity. With rising concerns that NHS primary care workload has increased substantially, what do the numbers tell us?

Researchers from the Nuffield Department of Primary Care and Health Sciences at Oxford and the Centre for Academic Primary Care, Bristol have assessed the direct clinical workload of GPs and practice nurses in primary care. Their retrospective analysis of both GP and nurse consultations at 398 English general practices, April 2007 – March 2014, is published in the Lancet.

The bottom line:  People in England are, indeed, visiting their GP practices more often, and are having longer consultations than they were in 2007, resulting in a 16% rise in clinical workload.

What did they do? The team looked at non-temporary patients registered. They used data from electronic health records routinely entered in the Clinical Practice Research Datalink, and linked CPRD data to national datasets.

The dataset comprised 101 818 352 consultations and 20 626 297 person-years of observation. Trends in age-standardised and sex-standardised consultation rates were modelled with joinpoint regression analysis.

Findings

• 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)
• Overall workload increased by 16%.

Scope: These data only explore direct clinical workload and not indirect activities and professional duties. The team deduce these “have probably also increased.”

Interpretation: The researchers conclude that their findings show a substantial increase in practice consultation rates, average consultation duration, and total patient-facing clinical workload in English general practice.

General practice in England nearing ‘saturation point’ as study reveals extent of GP workload increase, University of Bristol, 5 April

Reference: 

F D R Hobbs et al. Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007–14‘ The Lancet.

Sue Lacey Bryant
Workforce Development Tutor, Thames Valley
Health Education England
sue.laceybryant@thamesvalley.hee.nhs.uk