'Frequent attenders' account for four in 10 GP consultations, study finds

Four out of 10 patients seen by GPs are frequent attenders at the surgery, a study has found.

Research carried out by academics at the University of Manchester showed a large proportion of the workload for GPs was taken up by patients who made a disproportionate number of visits to the clinic.

The study defined frequent attenders as those who visited their GP more than 90% of all other patients in the same practice.

The number of consultations for those who were frequent attenders doubled in the past 20 years according to the study, which looked at more than 160 million consultation events from 12.3 million patients in 845 general practices between 2000 and 2019.

The study’s co-author Professor Evan Kontopantelis said: “This is the first study to show that frequent attenders, the top 10% of consulters, have largely and progressively contributed to increased workload in general practices across the UK over the last 20 years.”

The research, published in BMJ Open, found that GPs were carrying out more consultations over the telephone and online, but for frequent attenders face-to-face appointments continued to increase.

Professor Aneez Esmail, another co-author, said: “Our findings show that frequent attenders account for an increasing proportion of face-to-face consultations with GPs and are responsible for nearly 40% of consultations fairly constantly over time.”

Fellow co-author Dr Maria Panagioti said the findings could suggest a need for an increase in multi-disciplinary staff.

She said: “Indeed, the large increase in the general practice workload over the last 20 years means having extended multi-disciplinary teams is necessary to meet a wide range of patient needs through a range of ways such as remote consultations.”

Prof Kontopantelis added: “We feel the increasing demand for consultations from frequent attenders also needs to be evaluated in the context of the Covid-19 pandemic.

“Frequent attenders also may have special health and social care needs but for a variety of reasons we do not yet fully understand how best to meet them.”

Professor Martin Marshall, chairman of the Royal College of GPs, said: “As well as having more patients than 20 years ago, GPs and our teams are seeing more patients who are living with multiple, long-term conditions, who often require general practice care and services more frequently.

“As this research suggests, this is increasing the complexity of workload in general practice, as well as volume.

“GPs know and understand their patients and we’re able to deliver the care our patients with complex health conditions need because of the relationships we’ve built with them over time.

“This is why it’s so important that we’re able to maintain continuity of care in general practice for those who need it, but this involves being able to spend more time with patients – and whilst demand for appointments is high, and staffing pressures in general practice prevail, being able to offer longer appointments in general practice means being able to offer fewer overall.

“GPs and our teams are working under intense resource and workforce pressures. These pressures existed before the pandemic, but the crisis has only exacerbated them.

“We urgently need the Government to make good on its promise of 6,000 more GPs and 26,000 more members of the practice team – as well as introducing measures to tackle the ‘undoable’ workload in general practice – so that we’re able to deliver the care our patients need, including spending more time with them where necessary.”