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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.’