General practice delivering 'up to double the appointments it is paid for'

General practice in England may be delivering as many as double the number of appointments it is funded for, analysis by GPonline suggests.

GP consultation
(Photo: sturti/Getty Images)

General practice in England delivered nearly 350m appointments including COVID-19 vaccinations in the year to June 2022 according to figures from NHS Digital.

This total suggests that practices delivered around 5.7 appointments for every patient in the country within that 12-month period. NHS data also show that general practice delivered 367m appointments in 2021 - around six appointments per patient.

But analysis by GPonline suggests that the true figure could be between nine and 10 appointments per patient per year - a figure double the level practices were funded to provide when the current GP contract model took effect from 2004.

GP workload

Total appointments recorded by NHS Digital based on data from GP practice IT systems are likely to be a significant underestimate because they do not count telephone contacts with patients or home visits accurately.

Explanatory notes on the appointments data make clear that whereas face-to-face appointments are usually logged individually with one patient contact per booking, 'many telephone triage and home visits appear as one long blocked period of time which are not booked to individual patients'.

Polling by GPonline earlier this year found that GPs reported delivering 46 consultations on average per day - nearly double the safe limit recommended by the BMA. Based on this figure, the full-time equivalent, fully qualified workforce of 27,558 GPs would deliver around 280m consultations in 251 working days across a full year.

NHS data show that around half of appointments in general practice are delivered by GPs - suggesting that the real total number of appointments could be 550m-plus - more than nine contacts per patient per year.

Complexity

BMA GP committee member Dr Peter Holden told GPonline that something close to 10 appointments per patient per year was not an unrealistic estimate.

He added that in addition to large numbers of appointments, rising complexity of patient contacts had added further to intense pressure on general practice. This website reported earlier this month that one in five appointments in general practice now last more than 20 minutes.

Dr Holden said the practice-based GMS contract that took effect in 2004 - which remains the basis for GP funding - was resourced based on between four and five appointments per patient per year, in line with data from the now-defunct General Household Survey.

Suggestions that general practice is delivering far more appointments than the headline figures from NHS Digital show are supported further by analysis of the QResearch database published in 2009 - which showed that by 2008 the average patient had 5.5 consultations per year in general practice. This figure had risen sharply from 3.9 in 1995, the researchers found - and workload has intensified significantly since.

GP contract

Dr Holden, a BMA negotiator when the 2004 contract took effect, said: 'The GP contract is funded for about 45 minutes of my time per patient per year. About four consultations a year.

'Essentially as general practice does more and more, and hosps do less and less - or the NHS does more and we do a greater percentage of it - we are still funded in the old way and that no longer accounts for the growth in our business.

'The bottom line is we are now doing a lot more work. More is being done in primary care and moving out of hospital but we have not been resourced for it.'

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