Frequent attenders visit practices five times as often as other patients, according to a new UK study, published today.

A team at the University of Manchester analysed consulting patterns among the top 10% of consulting patients with: all staff, including admin staff, in the practice; only with GPs; and face-to-face consultations with all staff, and only with GPs.

When they looked at more than 160 million consultation events from 12.3 million patients, in 845 general practices between 2000 and 2019 and found that four out of ten of the workload at practices were with frequent attenders. The study, published in today’s BMJ Open, also noted that frequent attender consultations have doubled in the past 20 years, from a median of 13 in 2000 to 21 in 2019 and consultations with all staff members increased from 27 to 60.

The proportion of face-to-face consultations with GPs among frequent attenders rose from an average of 38% in 2000-01 to 43% in 2018-19, and from an average of 38% to 40% for all practice staff. On average, frequent attenders consulted about five times more often than the rest of the practice.

The researchers found that while face-to-face GP consultations remained relatively stable over the study period, telephone or online consultations became more common. In 2018/19 there was an average of 3.3 face-to-face consultations per patient per year with GPs, which rose to 8.7 consultations with GPs, including non-face-to-face such as telephone and online. All consultations by GPs per person increased from a median of five to eight per person per year and all consultations by all staff increased from 11 to 25. Distribution of face-to-face consultations with GPs was highest in Scotland, while the distribution of face-to-face consultations with all staff was highest in Northern Ireland.

Co-author Professor Evan Kontopantelis, of The University of Manchester, said: “This is the first study to show that frequent attenders, the top 10% of consulters, have largely and progressively contributed to increased workload in general practices across the UK over the last 20 years.”

Co-author Dr Maria Panagioti from The University of Manchester added: “These findings may also suggest the increase in multi-disciplinary staff working in general practices is perhaps the only solution for sustaining a viable primary care. Indeed, the large increase in the general practice workload over the last 20 years means having extended multidisciplinary teams is necessary to meet a wide range of patient needs through a range of ways such as remote consultations.”

The research concludes: “Frequent attenders appear to be a major driver for the increase in consultations that have contributed to perceptions of increased workload in general practice. GPs should be looking at this group of patients more closely to understand who they are and why they are consulting more frequently.”