Category: Medical Education

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.

Charlton K, Rees J, Burrow E. Identifying high cholesterol in the ambulance setting:a mixed-methods cohort study to tackle health inequality. J Public Health (Oxf).2024 May 29;46(2):277–85.

A recent study examined how people using a regional NHS ambulance service deal with high cholesterol (hyperlipidaemia) and their subsequent health behaviors. The study involved 203 participants, more than half of whom were diagnosed with high cholesterol. Interestingly, the study found that younger people and those with higher cholesterol levels were more likely to seek further medical management, while socioeconomic status (SES) did not seem to play a role in whether or not participants sought help.

One surprising finding was that while low SES is often linked to poor health, it did not predict whether someone had high cholesterol or if they would seek treatment for it. Instead, other factors like existing health conditions, health education, and personal behavior were more influential in determining whether someone would take steps to lower their cholesterol.

Many participants did not act on their high cholesterol diagnosis, often because they were dealing with other health issues they considered more urgent. Even though they received advice on managing cholesterol, many were confused about their diagnosis
and the risks, leading them to neglect further treatment or lifestyle changes that could help reduce their cholesterol levels.

The study also highlighted challenges like difficulty in getting follow-up appointments and issues with contact information, which further hindered engagement with healthcare. Some participants didn’t have an accurate phone number on record, making it hard to reach them for follow-up care, which may reflect broader issues of digital exclusion and health inequality.

The research underlines the need for better public health messaging and support systems that address these barriers, particularly for those with low SES. It suggests that improving initial engagement with cholesterol management could help reduce health inequalities and improve outcomes for those at risk of cardiovascular disease.

This study offers a fresh perspective by focusing on a group often overlooked in cholesterol research—those using emergency services—and highlights the complex factors influencing health behaviors and the importance of tailored approaches to public health interventions.

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