Complexity of patient consultations has increased across GP staff groups
Complexity of patient consultations is rising across a range of clinical staff in GP practices and has implications for role boundaries and supervision, a study has found.
Analysis of data from 369 practices in 2018 and 2021 found a big shift in the proportion of consultations done by ARRS staff including paramedics, pharmacists, physician associates, physiotherapists, nursing associates, advanced nurse practitioners and mental health practitioners.
The researchers from Bristol University found that ARRS involvement increased across all age groups, ‘most notably among older adults’.
And, comparing more than 3.5 million consultations before and after the scheme came in, researchers found that GPs, nurses and ARRS staff all saw an increase in the number of complex consultations they were managing.
The greatest shift was for practice nurses who went from 12% of consultations being classed as complex to 18.2%.
ARRS roles with direct patient contact saw an increase from 15.8% to 18.8%, while GPs’ proportion of complex consultations changed from 14.1% to 15.2%.
But reporting in the British Journal of General Practice, the team noted that the complexity being managed by physician associates remained steady over the period at around 11%.
Over the period, ARRS roles took on more consultations about cardiovascular disease, chronic pain, drug or alcohol abuse and people with multiple conditions, the study found.
It also identified that diagnostic ARRS roles were more likely than GPs to manage first consultations after diabetes diagnosis – mainly advanced nurse practitioners or pharmacists.
But GPs were more likely to manage chronic pain, dementia, mental illness and learning disabilities; as well consultations where three or more medicines were prescribed and those that led to an emergency admission.
There did appear to be clear specialisation within teams with pharmacists and mental health practitioners managing more drug and alcohol-related cases; pharmacists and physiotherapists seeing more chronic pain consultations; and paramedics having higher subsequent emergency admissions.
GPs remained more likely than anyone to be managing polypharmacy and multiple diagnoses, they reported.
In general, ARRS staff with diagnostic ability now manage a broader mix of complex and non-complex tasks, they concluded.
‘More than half of flagged complex consultations involved multiple long-term conditions, explaining much of this trend,’ they said.
The findings point to a redistribution of work ‘within an increasingly pressured system’, the researchers concluded.
‘While ARRS has broadened capacity and skill mix in primary care, rising consultation complexity appears to be a system-wide shift driven by ageing populations, deferred care, and post-pandemic recovery, rather than ARRS expansion alone.
‘Simply increasing role numbers is therefore unlikely to reduce GP workload,’ they continued.
‘PCNs should clarify role boundaries, implement standard referral and handover protocols, strengthen supervision and mentorship, and ensure adequate administrative support, especially in deprived areas,’ they added.
Overall, evidence on the safety, effectiveness, and appropriate scope of ARRS roles in managing complex cases remains limited, they stressed.
The findings come as a recent Public Accounts Committee report warned that the Government’s ‘hyper-focus’ on access has had knock-on consequences for GPs ability to offer preventive care for older people.
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