title: Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007-14.
abstract: BACKGROUND
  Primary care is the main source of health care in many health systems, including the UK National Health Service (NHS), but few objective data exist for the volume and nature of primary care activity. With rising concerns that NHS primary care workload has increased substantially, we aimed to assess the direct clinical workload of general practitioners (GPs) and practice nurses in primary care in the UK.
  
  
  METHODS
  We did a retrospective analysis of GP and nurse consultations of non-temporary patients registered at 398 English general practices between April, 2007, and March, 2014. We used data from electronic health records routinely entered in the Clinical Practice Research Datalink, and linked CPRD data to national datasets. Trends in age-standardised and sex-standardised consultation rates were modelled with joinpoint regression analysis.
  
  
  RESULTS
  The dataset comprised 101,818,352 consultations and 20,626,297 person-years of observation. The crude annual consultation rate per person increased by 10·51%, from 4·67 in 2007-08, to 5·16 in 2013-14. Consultation rates were highest in infants (age 0-4 years) and elderly people (≥85 years), and were higher for female patients than for male patients of all ages. The greatest increases in age-standardised and sex-standardised rates were in GPs, with a rise of 12·36% per 10,000 person-years, compared with 0·9% for practice nurses. GP telephone consultation rates doubled, compared with a 5·20% rise in surgery consultations, which accounted for 90% of all consultations. The mean duration of GP surgery consultations increased by 6·7%, from 8·65 min (95% CI 8·64-8·65) to 9·22 min (9·22-9·23), and overall workload increased by 16%.
  
  
  CONCLUSIONS
  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. Notably, our data only explore direct clinical workload and not indirect activities and professional duties, which have probably also increased. This and additional research questions, including the outcomes of workload changes on other sectors of health care, need urgent answers for primary care provision internationally.
  
  
  BACKGROUND
  Department of Health Policy Research Programme.
authors.affiliation: Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Oxford, UK. Electronic address: richard.hobbs@phc.ox.ac.uk.
authors.forename: F D Richard
authors.initials: FDR
authors.lastname: Hobbs
authors.affiliation: Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Oxford, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Bankhead
authors.affiliation: Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Oxford, UK.
authors.forename: Toqir
authors.initials: T
authors.lastname: Mukhtar
authors.affiliation: Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Oxford, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Stevens
authors.affiliation: Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Oxford, UK.
authors.forename: Rafael
authors.initials: R
authors.lastname: Perera-Salazar
authors.affiliation: Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Oxford, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Holt
authors.affiliation: Centre for Academic Primary Care, School of Social and Community Medicine, Canynge Hall, Bristol, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Salisbury
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004739:England; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016526:Workload / Q000706:statistics & numerical data*; D055815:Young Adult