Identifying high-frequency attendees in general practice

Glenda Anne Cook; Akhtar Ali; Roger Dykins; Robin Hudson; Julie Johnston; Jill Mitchell

doi:10.3399/bjgp17X691529

INTRODUCTION

Primary care is critical to the effectiveness and sustainability of the health system in the UK. This is recognised in the current transformation of health care that aims to provide care and treatment in the community rather than through hospital-centred services.¹^,² The effects of an ageing population with complex multiple morbidities, coupled with increased consumerism, have placed an unprecedented demand for access to general practice. Combined with specific supply-side factors, including diminished funding of general practice and an imminent recruitment crisis, this brings to the fore the need for new approaches to delivering primary care.

FREQUENT ATTENDERS AND PRACTITIONER BEHAVIOURS

One area that has received little attention within the context of transformation is the phenomenon of a proportion of the registered practice population consulting their GP frequently.³^–⁵ Gill and Sharpe’s 1999 systematic review of frequent consulters in general practice concluded that there were two general approaches used to define a frequently consulting group. One approach is to identify a cut-off point in the distribution of consultation activity (for example, top quartile). The other approach is based on a minimum number of consultations (for example, a cut-off of 9–14 consultations per annum). These patients have highly complex health problems, including combinations of multimorbidity, frailty, dementia, polypharmacy, and problems requiring complicated management plans. Personal circumstances and health anxiety are also prevalent.

Practitioner behaviours also contribute to regular consultations by frequently attending patients. A welcoming approach with positive regard maintains interaction. Hence, when a patient is …

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