Frequent attenders consult their GP five times as much as other patients and account for four in 10 appointments, a study has shown.
The large analysis of 1.7 billion consultations with more than 12 million patients also found the proportion of frequent attenders has risen over the past two decades.
Looking at consulting patterns among the top 10% of patients attending the most, they found that for all practice staff including admin staff, consultations more than doubled, from an annual average of 11 per person in 2000–01 to 25 in 2018–19.
Over the same period, all types of consultations – face to face, remote and telephone – with GPs rose from an average of 13 to 21 a year.
For other other practice staff, consultations for this group rose from an average of 27 a year to 60, the researchers report in BMJ Open.
The researchers said figures help to explain the rise in workload that GPs have sounded the alarm about in recent years.
And that it was not a critique of patients but suggested the system was not resolving their problem, perhaps because of lack of access to other services.
The analysis showed that the proportion of consultations attributed to frequent attenders increased over time particularly for face to face appointments, rates of which fell for other patients.
The figures showed relatively little regional variation with the exception that face to face GP consultations were highest in Scotland and didn’t seem to be linked to levels of deprivation.
‘This striking finding suggests that a relatively small number of patients are accounting for a large proportion of GP workload including face-to-face consultations,’ they concluded.
‘While many of these patients may have comorbidities and may need to be seen regularly, research suggest that they have wider social and psychological needs.
‘GPs should be looking at this group of patients more closely to understand who are they and why are they consulting more frequently.’
Study leader Professor Evan Kontopantelis, professor of data science and health services research at the University of Manchester said they were now hoping to find out more about detail on a patient level which he suspected would flag up issues such as mental health problems and nowhere for GPs to refer them.
‘The workload for GPs has risen tremendously. Anecdotally – because we don’t yet have patient characteristics – we expect to see changes to referrals to secondary and community care. This will have been exacerbated by the pandemic.
‘We think because there’s little chance of referral people then go back to primary care and it becomes a revolving door. We do need to better understand what’s happening with these people in the system.’
READERS' COMMENTS [7]
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FATPOA
Not a new finding but confirms what has always been so. The fact that someone comes very often may not mean though they have a ‘mental health’ problem . This could be learned behavior if each attendance results in an action. In days of old with the availability of a named dr and continuity we were taught that this can be managed by a consistent approach with pre booked ‘rationed’ advance appointments to keep the lid on things. It was rare for this group to be the ‘sickest ‘. They do though use a massive amount of resource though and as a GP the easiest way to move them on is to prescribe or refer and re enforce the re attendance. Very occasionally there will be a lightbulb moment or disclosure that opens a whole new perspective and then often a much reduced attendance.
Sorry but this sounds like a study to state the bleedin’ obvious. Surely if you’re a “frequent attender” you attend “frequently” (?) All it seems to have done is put a number on. Frontline clinicians already know that 10% of their list account for 90% of the work. Can their be a study that actually explains what the more frequent attender is actually after??
This isn’t a tongue in cheek remark: consider directing (NOT referring- no breech of confidentiality) them to the local MP’s regular Friday or Saturday surgery.
For ongoing issues with a significant social component that’s what I do, where appropriate.
After all, MPs are so much better than the rest of us and can fix everything, right ?
Dear NT (12.16pm) At least the bleedin’ obvious is now evidence based …
You can’t find a code for “them” to warn the ENTIRE system of their monthly arrival it seems, hypochondriasis and somatic fatigue is as close as it gets. __**Funny that there’s a code for frequent non-attender, and not attender! I guess, because medicalistion pays some company somewhere. And eventually an insurance company.
Is it too soon to suggest this is how Shipman managed 3500 patient list singlehandedly?