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General practice ‘reaching saturation point’, landmark study concludes

General practice in England could be reaching ‘saturation point’, with patients seeing GPs more often and for longer while GP numbers fail to increase, according to a new study published in the Lancet.

The study is the largest analysis of GP and nurse consultations to date, and shows that general practice workload has increased by 16% from 2007 to 2014 while patients are seeing their GP 14% more than they did seven years ago. 

While the overall workload has increased, the number of GPs per patient has decreased from 60.9 GPs per 100,000 patients to 60.6, it found.

The authors said that the number of consultations have increased ‘substantially’ at the same time as recruitment remains ‘low’.

As a result, the system has reached ‘saturation point’, the authors conclude.

The BMA and RCGP said that the study, led by researchers from the University of Oxford, provides ‘clear evidence’ for what they have been saying for years.

Pulse has been carrying out its Battling Burnout campaign over the past three years, highlighting the stress that GPs are under partly due to increasing demand.

The authors of the landmark study said that GPs had been highlighting the increasing workload for years and, ‘for the first time, we are able to provide objective data that this is indeed the case’.

The study covered over 100 million GP and nurse consultations at 398 general practices in England.

It found:

  • There were 1,270 days of appointments per 10,000 patients in 2014, compared with 1,095 days in 2007.
  • Consultations are longer now than in 2007, with average length rising 5% from 8.45 minutes to 8.86 minutes
  • The number of GP consultations overall (including telephone, face-to-face consultations and home visits) increased by 13.67% in the period studied, from 3.35 to 3.80 consultations per patient per year.

The analysis does not include other activities such as hospital referrals, teaching or CPD, which accounts for around 40% of GP work time, with the authors warning that workload pressures are likely to be higher than they have found.

The study concludes: ‘Our findings show a substantial increase in practice consultation rates, average consultation duration, and total patient-facing clinical workload in English general practice. These results suggest that English primary care as currently delivered could be reaching saturation point.’

Professor Richard Hobbs, head of the Nuffield Department of Primary Care and Health Sciences, University of Oxford, and lead author of the study said: ‘For many years, doctors and nurses have reported increasing workloads, but for the first time, we are able to provide objective data that this is indeed the case.

‘The demands on general practice have increased substantially over the past seven years. Recruitment of new GPs and nurses remains low while the population in England steadily increases. As currently delivered, the system seems to be approaching saturation point.’

Dr Maureen Baker, RCGP chair, said: ‘This important research confirms what the College has been saying for years. GPs and our teams are making more consultations than ever before, and our patients are living longer and with multiple, long-term conditions, meaning that our workload is growing in complexity as well as volume.’

Dr Richard Vautrey, GPC deputy chair said: ‘This study provides clear evidence which supports what every GP and patient knows: GP practices are working harder than ever before, but are struggling to provide even basic levels of care as they are overwhelmed by unsustainable workload.

‘In many cases this is beginning to put patients at risk as services become over stretched, while an understaffed GP workforce is being further depleted as staff leave owing to burnout and stress.’

A DH spokesperson said: ’With an ageing population, GPs are seeing more patients with complex health conditions than ever before. That is why we are investing in safer 7-day services and boosting the primary care workforce.

’The new GP contract agreed with the BMA will include an extra £220million, on top of NHS England’s commitment to increase investment in general practice by 4.5% every year. Thousands of GPs are also offering video and telephone consultations, helping them attend to patients more quickly.’

Readers' comments (34)

  • Vinci Ho

    (1)Hence , making more routine GP appointments available on Saturday and Sunday is getting blood out of stone.
    (2) The risk of making mistakes is elevating because of saturation point while CQC shows no mercy to punish practices whenever and wherever possible.
    (3) A vicious cycle of negative feedback will make recruitment and retention harder and harder .

    The potential harm on patients this government can cause is a matter for duty of candour for all medical professionals , academic or frontline......,

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  • Found another 'GP to sort out possible cancer' in my 100s of letters again. Did the patient even know?
    You know the answer friends...

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  • The inevitable consequence of "free at the point of delivery" is abuse of the system.Whilst charging for appointments is a blunt instrument, desperate times may need desperate measures.
    People are not dropping dead in the streets of Dublin for want of a few euros to see their GP.

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  • "There were 1,270 days of appointments per 10,000 patients in 2014, compared with 1,095 days in 2014."

    Which years? Am pretty sure they are not the same.

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  • And what happens after 'saturation'? Precipitation of the insoluble.

    What a vacuous study.Maybe I should write a paper on whether the Pope is Catholic.

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  • 'We welcome the news that saturation point has now occurred, and it has never been a better time to be a GP'

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  • A saturation point is a brittle physical entity. All you need is a small disturbance or new nidus for the super concentrated environment to coalesce into clumps that then fall out of the system unable to return leaving the remaining particles to take the heat.......

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  • It is worse than the headlines.
    Dumped work is expanding even faster. My usual game to keep me alert when I check my letters at 8pm is 'where is the cancer'.
    I usually find at least one hidden 'GP to chase possible cancer patient has no idea about' letter each time.

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  • Paul Cundy is quite correct. However Primary Care has to fail to implement newer models of care!
    If one reads the leaked presentation from this website

    "www.digitalhealth.net/includes/images/news0254/PDF/overview-evidence-review-of-data-and-information.pdf"

    One will find that the DOH/NHSE would like primary care to find efficiency by "restricting access to non-digital channels" and moving all patients to online booking/triage and self-help advice which allegedly saves money (page 23).

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  • This study is already out of date. April 2016 is far busier than December 2014. Less GPs more work more expectations more shift of work from secondary care more dumping from everywhere more retirements. 4 gp partners locally have resigned and now doing locums since beginning of the month.
    I am seriously considering that option as well.

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