A novel study has revealed that ‘frequent attenders’ comprise around four in ten GP appointments in England, potentially exposing the reason behind the growing strain on GP resources.
Frequent attenders now make up nearly 40% of GP appointments in England, with the proportion of such patients rising dramatically over the last few decades. Now, an extensive long-term study has comprehensively analysed the reasons behind these patients, potentially revealing how to alleviate the burden on healthcare systems.
The study’s findings are published in the open access journal BMJ Open.
Effects of frequent attenders
Frequent attenders, on average, have five times as many GP appointments as other patients on a general practice list, signifying the reason behind the rise in GP workload. In recent years, general practitioners have raised concerns over their growing workload, which has also been influenced by an ageing population, the complexity of care needs, and initiatives to shift care from hospitals into the community.
However, there has been little research on the contribution of frequent attenders on their workload, with preliminary data indicating that the top 10% of patients could be responsible for between 30% to 50% of all GP appointments. The team analysed the type and distribution of GP appointments over a 20-year period to investigate this.
A deeper look at GP appointments
The researchers employed anonymised information on 1.7 billion consultations with 12.3 million patients, which were submitted to the Clinical Practice Research Database by 845 GP practices across the UK between April 2000 and March 2019. Furthermore, only 113 practices contributed data throughout the entire study period.
They analysed consulting patterns amongst the top 10% of consulting patients, investigating how much time was spent consulting by all staff (including admin staff) and GPs (face-to-face, remote, and phone consultations).
They found that all types of consultations with all staff more than doubled, 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 five in 2000-01 to eight per person in 2015-18.
For frequent attenders, all types of GP appointments rose from an average of 13 to 21 per year, whilst those with other practice staff increased from an average of 27 each year to 60 between April 2000 and March 2019.
Overall, around four in ten of all types of GP consultations involved frequent attenders, with the proportion of consultations attributed to them increasing over time, most notably face-to-face GP appointments, of which the rates fell for other patients.
Face-to-face GP appointments increased 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. On average, frequent attenders were consulted around five times more often than the rest of the practice list.
The regional variation was minor in any of the trends studied, with 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.
The data highlighted that an area’s level of deprivation did not influence frequent attendance; however, prior European studies have indicated that frequent attenders are more likely to be female, older, have more social and psychiatric problems, take more drugs for mental illness, have more medically unexplained symptoms, and more long-term conditions.
Due to this being an observational study, no conclusion can be made about cause and effect, with the researchers stating that they used their own definition of frequent attenders.
The researchers said: “A relatively small number of patients are accounting for a large proportion of GP workload including face-to-face consultations.
“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.”