Activity in general practice has risen in the last three complete financial years, but most of this has been for medical professionals other than GPs, research by a leading health think thank suggests.
The Nuffield Trust analysed activity data from 337 practices out of 8,000 in England, covering over 3.2 million registered patients, between 2010-11 and 2013-14, and has shared the findings exclusively with HSJ.
Activity data is not routinely collected for general practice, unlike the acute sector, so this is the most detailed information available since the last formal publication of estimates in 2009.
However, the Nuffield Trust has warned about “scaling up” its findings to create a picture of national trends. It is unclear how representative the sample is, and it has not been adjusted for local contextual factors.
There may also be discrepancies in how patient contacts have been recorded by different practices.
The total number of patient consultations increased by around 11 per cent during this period at the practices analysed, but consultations with GPs increased by only 2 per cent, the analysis found.
By contrast, consultations with nurses grew by 8 per cent and consultations with other professionals, such as pharmacists, physiotherapists, and speech therapists, climbed by 18 per cent.
The number of consultations per person registered on a practice list, per year rose from 7.6 to 8.3. The researchers said this was “in line with what we would expect from trends over the previous decade”.
The findings from the sample appear to contradict the assumption that growing pressure in general practice, which GP representative bodies have repeatedly warned about, has been caused by GPs dealing with more patient consultations.
Nuffield Trust chief executive Nigel Edwards said GPs may be experiencing greater administrative burdens, partly from having to manage extra staff.
He pointed out that while “the supply of GPs is relatively fixed… the supply of these other types of staff is more elastic”. Therefore if general practice came under greater demand pressure “you would expect [to] see an increase in these other staff groups taking on the load”.
He said an 11 per cent increase in consultations overall “would certainly be something you’d notice”. This is “being experienced at the practice level, which probably is creating extra work for GPs as well, even though patients are being seen by other staff”.
Mr Edwards said the research also pointed to a wider problem of the lack of data available in primary care compared to the acute sector, making it difficult to identify where the pressure on general practice is coming from.
“At the moment we’ve got anecdotes about how tough it is– not to say they aren’t true – but without actual data, we don’t know how to plan,” he added.
Mr Edwards highlighted the example of pharmacists, who policymakers have suggested could be used to relieve burden on general practice.
“Unless we’ve got proper demand data, we don’t really have a feel of how much pharmacists could help.”
Mr Edwards called for data on the overall workload in general practice to be publicly available “at the very least”, but also how many patients are being seen across practices, which would be triangulated with how many prescriptions are being written and how many referrals are being made “to see if there are any proxies for the complexity of the work”.
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