Consultation rate and mode in English general practice, 2018 to 2022: a population-based study by deprivation

Abstract

Background The COVID-19 pandemic has had a significant impact on primary care service delivery. With general practice delivering record numbers of appointments and rising concerns around access, funding and staffing in the UK National Health Service, we assessed contemporary trends in consultation rate and mode (face-to-face versus remote). Methods We did a retrospective analysis of 9,429,919 consultations by GP, nurse or other health care professional between March 2018 and February 2022 for patients registered at 397 English general practices. We used routine electronic health records from Clinical Practice Research Datalink Aurum with linkage to national datasets. Negative binomial models were used to predict consultation rates and modes (remote versus face-to-face) by age, sex, and socio-economic deprivation. Findings Overall consultation rates increased by 15% from 4.92 in 2018-19 to 5.66 in 2021-22 with some fluctuation during the start of the pandemic. Consultation rates increased with deprivation. The breakdown into face-to-face and remote consultations shows that the pandemic precipitated a rapid increase in remote consultations across all groups but varies by age. Socioeconomic differences in consultation rate, adjusted for sex and age, halved during the pandemic (from 0.36 to 0.18 more consultations in the most deprived). The most deprived saw a relatively larger increase in remote and decrease in face-to-face consultations rates. Interpretation Substantial increases in consultation rates imply increased pressure on general practice. The narrowing of consultation rates between deprivation quintiles is cause for concern, given ample evidence that health needs are greater in more deprived areas. Funding No external funding.

Health Care Resource Utilization and Costs Associated With COVID-19 Among Pediatrics Managed in the Community or Hospital Setting in England: A Population-based Cohort Study

“…In the present study, the proportion of patients in the overall cohort with ≥1 F2F consultations was similar (2.3%) to the proportion with ≥1 telephone consultations (2.6%), which corresponds to Vestesson et al’s 37 estimates during the pandemic. However, the proportion of patients to have experienced a telephone consultation was higher than the proportion to experience a F2F consultation among patients at higher risk to severe COVID-19 (7.8% vs. 4.8%) and patients in the immunocompromised group (5.0% vs. 2.8%).…”

“…These patterns may in-part reflect evidence showing that respiratory care for mild symptoms was less frequently sought for older pediatric patients than younger children, 16 and that younger children with respiratory infections are perceived as more vulnerable by their caregivers due to difficulties with communication and concerns of rapid deterioration of health in the younger ages. 38 In the present study, the proportion of patients in the overall cohort with ≥1 F2F consultations was similar (2.3%) to the proportion with ≥1 telephone consultations (2.6%), which corresponds to Vestesson et al's 37 estimates during the pandemic. However, the proportion of patients to have experienced a telephone consultation was higher than the proportion to experience a F2F consultation among patients…”

“…Our findings that patients 1-4 years old more often had a primary care consultation than older pediatric patients is consistent with prior studies using CPRD pre-and within-pandemic data. 35,36 In particular, Vestesson et al 37 found that between March 2018 and February 2022, patients <5 years of age sustained the highest consultation rates in the pediatric group regardless of the mode of consultation (remote vs. F2F). These patterns may in-part reflect evidence showing that respiratory care for mild symptoms was less frequently sought for older pediatric patients than younger children, 16 and that younger children with respiratory infections are perceived as more vulnerable by their caregivers due to difficulties with communication and concerns of rapid deterioration of health in the younger ages.…”

Stressed and overworked: What the Commonwealth Fund’s 2022 International Health Policy Survey of Primary Care Physicians in 10 Countries means for the UK

“…For example, GPs in our survey thought remote consultations could lead to greater antibiotic prescribing and more diagnostic tests -and other evidence suggests remote GP consultations are associated with higher antibiotic prescribing in adults compared to in-person appointments. 80 But telehealth also presents opportunities for better access and more convenience for patients -and evidence suggests a significant proportion may prefer remote consultations for some needs. 22,81 Remote consultations will likely remain an important part of how care is delivered in future 82 and best practice on their use in general practice is now emerging.…”

Antibiotic prescribing in remote versus face-to-face consultations for acute respiratory infections in English primary care: An observational study using TMLE

“…The digitalisation of general practice was accelerated by the COVID-19 pandemic and has led to an ongoing increase in the use of remote consultations for all ages. (3) The full extent of the consequences of this rapid shift towards ‘telemedicine’ is still unclear and one area of concern is increased antibiotic prescribing in remote consultations. A survey of GPs in the UK reported that 67% of GPs thought that telehealth has increased their antibiotic prescribing to either a great extent or some extent which corroborates this concern.…”