General practice consultations in England soared in number from 217.3 million in 1995 to 300.4 million in 2008, according to new data.

A typical GP practice in England conducted 34,200 consultations in 2008, compared with 21,100 in 1995, and the average patient had 5.5 consultations last year compared with 3.9 in 1995, research commissioned by the NHS Information Centre has revealed.

The study, which was conducted using the QResearch general practice database, also shows a change in the proportion of patients seen by nurses in primary care. In 1995, 76% of consultations were undertaken by GPs, 21% by nurses and 3% by other clinicians. In 2008, around 62% of consultation were conducted by GPs, while 34% were undertaken by nurses and 4% by other clinicians. However, this rise in the proportion of consultations undertaken by nurses could easily reflect increased recording on computer by nurses as well as a true increase in the total numbers of patients seen by a nurse each year, according to the study’s authors, Professor Julia Hippisley-Cox and Yana Vinogradova.

There has also been a change in where consultations take place. In 1995, 86% of GP consultations were conducted in surgery premises, while 3% were by telephone, 9% were home visits and 2% were conducted at other locations. By 2008, 82% of GP consultations took place in the surgery, 12% were on the phone, 4% were home visits and 3% were conducted in other locations.

However, the trebling of telephone consultations and halving of home visit numbers during the period have to be set in context, since the absolute rates of both phone and home visits were low compared with surgery consultations, say the authors. The decline in home visits is likely to reflect changes in the delivery of out-of-hours (OOH) care over the last 14 years, including the establishment of cooperatives for OOH care and the its removal from GPs’ contractual responsibilities, they add.

Consultation rates vary markedly by age and sex, the study reveals, with the highest rates found in the elderly. For example, in 2008 the highest overall consultation rates occurred among people of both sexes aged 85-89 (men had 13.8 consultations per person/year and women had 13.3).

The authors point out that the study did not take account of the complexity of consultations, the number of tasks undertaken within consultations, prescribing and referral rates, investigations or the co-morbidity of patients – all of which are likely to have increased over the last 14 years. Nor did the analysis take account of the consultation’s duration, which they say is again likely to have increased since 1995, as has been shown by the 2006-7 General Practice Workload Survey.

- The QResearch database was developed by the University of Nottingham and IT systems supplier EMIS. The database contains over 40 million patient years from 573 practices spread throughout the UK, with data extending back to the early 1990s.