A relatively small number of patients are accounting for a large proportion of GP workload, including face-to-face consultations, according to a UK study by University of Manchester experts.
The study of over 160 million consultation events from 12.3 million patients, in 845 general practices between 2000 and 2019 showed four out of ten of the workload at GP clinics were with frequent attenders.
Frequent attenders were patients making a disproportionately higher number of visits to GP clinics each year, defined as more than 90% of all other patients in the same practice.
The study, published in BMJ Open also found that among frequent attenders, consultations at GP clinics have doubled in the last 20 years.
Consultations with GPs increased from a median of 13 in 2000 to 21 in 2019 and consultations with all staff members of GP clinics increased from 27 to 60.
Also, according to the study, face-to-face GP consultations were relatively stable over the study period, whereas other forms of consulting such as telephone or online consultations have become more common.
In 2018/19 there was an average of 3.3 face-to-face consultations per patient per year with GPs. However. the number rose to 8.7 consultations with GPs, including non-face-to-face, like telephone and online.
That means, say the researchers, that GPs are consulting more with patients but using a variety of means.
Frequent attenders, though, are an exception because their face-to-face consultations continues to increase over time.
The findings show the traditional model of patients consulting with GPs face to face is being replaced by a new model of work in general practice: increasing numbers of consultations are conducted by other staff members, rather than GPs, using alternative means to face-to-face consultations.
Co-author Professor Evan Kontopantelis from The University of Manchester 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."
Co-author Professor Aneez Esmail from The University of Manchester 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."
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
Co-author Dr Maria Panagioti from The University of Manchester said: "But these findings may also suggest the increase in multi-disciplinary staff working in general practices is perhaps the only solution for sustaining a viable primary care.
"Indeed, the large increase in the general practice workload over the last 20 years means having extended multidisciplinary teams is necessary to meet a wide range of patient needs through a range of ways such as remote consultations."
Professor 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."
In addition, they found that:
All consultations by GPs per person increased from a median of 5 to 8 pr person per year and all consultations by all staff increased from 11 to 25.
However, face-to-face consultations by GPs and face-to-face consultations by all staff remained static and may even have decreased.
Distribution of face-to-face consultations with GPs was highest in Scotland and the distribution of face-to-face consultations with all staff was highest in Northern Ireland.
There was little evidence of regional variability elsewhere in the attribution of all consultation types in study, across all categories of consulters.
Consultation patterns and frequent attenders in UK primary care from 2000 to 2019: a retrospective cohort analysis of consultation events across 845 general practices is published in BMJ Open