Describing the content of general practice consultations: a national morbidity study

Conference: 
SAPC ASM 2019 - Exeter
Talk Code: 
6E.1
Presenter: 
Clare Bankhead
Co-authors: 
Alice Fuller, Richard Hobbs, Tim Holt, Sarah Lay-Flurrie, Brian Nicholson, Rafael Perera-Salazar, Chris Salisbury
Author institutions: 
University of Oxford, University of Bristol (Chris Salisbury)

Problem

General practice is central to provision of healthcare in the NHS. However, little is known about the content of consultations – who consults, how often, or with what sorts of problems. Most of the information available comes from the 4th national morbidity study, conducted more than 20 years ago. Since then much has changed: the population has aged; many people are living with chronic conditions, which are frequently managed in primary care; and rates of risk factors have changed. We have analysed the content of general practice consultations, aiming to provide an updated national morbidity study to provide an invaluable resource for healthcare education, planning and policy.

Approach

Using a 10% age-sex stratified random sample of 304,937 people and 1.7 million consultations from the Clinical Practice Research Datalink (CPRD), we mapped all the codes recorded during 1 year (2013/2014) to the International Coding in Primary Care (ICPC-2) scheme. Three main outcomes were calculated: the proportion of consultations attributable to conditions; consultation rate/person years; and annual consulting prevalence. These were all reported by age and gender for each of the 17 ICPC-2 chapters and for specified exemplar conditions.

Findings

57% of all consultations contained codes in the General and Unspecified chapter, including issues such as blood pressure measurement, medication reviews and lifestyle advice. Respiratory conditions were the next most frequently coded chapter, accounting for just over 10% of consultations (consultation rate of 46 consultations/100 person years and consulting prevalence of 26.5/100 person years); skin conditions occurred in 9% of consultations and musculoskeletal complaints in 8%. The next most commonly coded ICPC-2 chapters were cardiovascular problems, digestive issues, endocrine/metabolism, female genital problems, pregnancy/family planning, psychological, ear, urological problems occurring in 2% to <5% of consultations and neurological, eye, male genital conditions, blood disorders and social problems in less than 2% of consultations.High consultation rates in infants especially for respiratory concerns (128.2 consultations per 100 person years), skin complaints (66.1 consultations per 100 years) and digestive concerns (55.5 consultations per 100 person years) were observed. Consultation rates were also high regarding pregnancy and contraception amongst women aged 15-44. Several of the ICPC-2 chapters (neurological, urological, musculoskeletal and psychological chapters) showed patterns of increasing consultation rates with increasing age. Patterns of prevalence rates were similar.

Consequences

We have shown that a significant proportion of consultations are about respiratory, skin and musculoskeletal problems. This has implications for medical education since the latter two types of condition receive relatively little attention in many curricula. We have also shown that many consultations include general activities but cannot be attributed to any specific health condition which raises difficulties for research and health service planning.

Submitted by: 
Clare Bankhead
Funding acknowledgement: 
This project was funded by the National Institute for Health Research School for Primary Care Research (project number 243) and was supported by the NIHR Oxford Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.