Trends in Primary Care Workload

de Dumast L, Moore P, Snell KIE, Marshall T. Trends in clinical workload in UK primary care 2005–2019: a retrospective cohort study. Br J Gen Pract. 2024 Apr 15;BJGP.2023.0527.

 

This study explored the changing workload in UK general practice between 2005 and 2019, focusing on consulting rates and consultation durations for GPs and practice nurses. The research considered both direct patient care (face-to-face and telephone consultations), and patient-related administrative tasks.

 

The findings showed a significant increase in overall workload for both GPs and nurses, with a notable rise in administrative tasks for GPs, influenced by factors such as direct access to diagnostic services, the shift of work from secondary to primary care, and the introduction of the Quality and Outcomes Framework (QOF). This framework, introduced in 2004, rewarded improvements in long-term condition management but probably contributed to the rise in GP administrative duties. From 2014 onwards, clinical workload plateaued, though the increase in administrative work compensated for the decline in face-to-face consultations.

 

The study’s main strength lies in its comprehensive data collection, covering nearly 70 million person-years of observation, making it a large analysis of clinical workload. However, limitations include the exclusion of data post-2020 due to disruptions caused by the COVID-19 pandemic, and potential inaccuracies in consultation duration recording.

 

The findings align with previous research showing increased GP consultations and longer consultation times. Additionally, multi-morbidity prevalence, defined as two or more long-term conditions, rose from 22.5% in 2005 to 31.6% in 2019, contributing to the rising workload. Patients with multi-morbidity had more frequent and longer consultations compared to those without. This is something I have also experienced. From an anecdotal view, patients are also better informed, are more likely to be aware of what is available in terms of treatment and intervention, and I feel things have become more transactional. The study is an observational one, so care needs to be exercised in drawing inferences, but it does highlight the requirement for primary care adjustments to accommodate the growing complexity of patient needs, especially with fewer full-time equivalent GPs available.