Primary care consultation length by deprivation and multimorbidity in England: an observational study using electronic patient records

Abstract

BackgroundLonger GP consultations are recommended as one way of improving care for people with multimorbidity. In Scotland, patients who are multimorbid and living in deprived areas do not have longer consultations, although their counterparts in the least deprived areas do. This example of the inverse care law has not been examined in England.AimTo assess GP consultation length by socioeconomic deprivation and multimorbidity.Design and settingRandom sample of 1.2 million consultations from 1 April 2014 to 31 March 2016 for 190 036 adults in England drawn from the Clinical Practice Research Datalink.MethodConsultation duration was derived from time of opening and closing the patient’s electronic record. Mean duration was estimated by multimorbidity level and type, adjusted for number of consultations and other patient and staff characteristics and patient and practice random effects.ResultsConsultations lasted 10.9 minutes on average and mean duration increased with number of conditions. Patients with ≥6 conditions had 0.9 (95% confidence interval [CI] = 0.8 to 1.0) minutes longer than those with none. Patients who are multimorbid and with a mental health condition had 0.5 (CI = 0.4 to 0.5) minutes longer than patients who were not multimorbid. However, consultations were 0.5 (CI = 0.4 to 0.5) minutes shorter in the most compared with the least deprived fifth of areas at all levels of multimorbidity.ConclusionGPs in England spend longer with patients who have more conditions, but, at all multimorbidity levels, those in deprived areas have less time per GP consultation. Further research is needed to assess the impact of consultation length on patient and system outcomes for those with multimorbidity.