Consultation rate and mode in English general practice, 2018 to 2022: a population-based study by deprivation

Abstract

AbstractBackgroundThe COVID-19 pandemic has had a significant impact on primary care service delivery. With general practice delivering record numbers of appointments and rising concerns around access, funding and staffing in the UK National Health Service, we assessed contemporary trends in consultation rate and mode (face-to-face versus remote).MethodsWe did a retrospective analysis of 9,429,919 consultations by GP, nurse or other health care professional between March 2018 and February 2022 for patients registered at 397 English general practices. We used routine electronic health records from Clinical Practice Research Datalink Aurum with linkage to national datasets. Negative binomial models were used to predict consultation rates and modes (remote versus face-to-face) by age, sex, and socio-economic deprivation.FindingsOverall consultation rates increased by 15% from 4.92 in 2018-19 to 5.66 in 2021-22 with some fluctuation during the start of the pandemic. Consultation rates increased with deprivation. The breakdown into face-to-face and remote consultations shows that the pandemic precipitated a rapid increase in remote consultations across all groups but varies by age. Socioeconomic differences in consultation rate, adjusted for sex and age, halved during the pandemic (from 0.36 to 0.18 more consultations in the most deprived). The most deprived saw a relatively larger increase in remote and decrease in face-to-face consultations rates.InterpretationSubstantial increases in consultation rates imply increased pressure on general practice. The narrowing of consultation rates between deprivation quintiles is cause for concern, given ample evidence that health needs are greater in more deprived areas.FundingNo external funding.Research in contextEvidence before this studyPressure on general practice has increased over recent years and there is consensus that the COVID-19 pandemic added to this. There is also consensus that the way general practice is delivering care has changed with increased use of remote consultation but there no estimates of the full extent of this and uptake by different groups. A seminal paper - Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007–14 – found an increase in consultation rates over the study period and in increased reliance on telephone contacts even before the pandemic.Added value of this studyThis study reports recent data for general practice consultation rates overall and by delivery mode. Our findings show that overall consultation rates were higher in 2021-22 than prior to the pandemic and that there has been a shift from face-to-face to remote consultations. However, the increase in overall consultations rates varies between index of multiple deprivation quintiles when adjusting for age and sex. These findings are based on close to 10 million consultations and 2 million person-years of observation from a validated data base of routinely collected electronic clinical records (the Clinical Practice Research Datalink Aurum).Implications of all the available evidenceOur analysis shows that general practice is busier than ever. We provide details on the use of remote versus face-to-face consultations by different patient groups over time. The narrowing of the difference between consultation rates of deprivation quintiles implies increasing health inequality in the population as existing differences in health needs are therefore not fully reflected in the consultation rates. The relatively larger increase in remote consultation rates and drop in face-to-face consultations for the most deprived provides detail on what type of consultations different patient groups receive but also raises additional questions.