Peaks and troughs of GP workload
Professor Simon de Lusignan, Medical Director Royal College of General Practitioners Research and Surveillance Centre and Professor of Primary Care & Clinical Informatics – University of Surrey
General practices are among the most pressured services and patients can present with a whole range of conditions. The RCGP Research and Surveillance Centre (RSC) is the principle primary care public health surveillance system in England, and its reports can provide insight into what diseases and conditions are more prevalent at a particular time of year, and on year-by-year trends.
There are some conditions that have winter peaks, some peak in the summer, and others are unpredictable.
Winter peaks in workload
Acute bronchitis and the common cold are examples of conditions that have winter peaks. The figure shows consultation rates per week for new episodes of acute bronchitis and the common cold, and how in the winter these are four to five times their summer levels. Higher rates of these conditions persist well into the third or fourth month of the year (week 12 to 17).
Figure 1: Bronchitis & the common cold have winter peaks in primary care
Summer and other peaks in workload
A common condition with peaks in spring and summer is allergic rhinitis (hay fever). This condition, although it can have a perennial form, has one of the most marked seasonal presentations of any in general practice. There are two peaks in its incidence, with the first peak around week 17 (20-16 April) and a second, generally larger peak around week 25 (15-21 June).
Figure 2: Peaks in allergic rhinitis presenting to general practice
Within 6 weeks or so of the summer peak in the presentations of hay fever and allergic rhinitis, both return to their baseline levels.
Unpredictable changes in workload
Although in certain times of the year, peaks in respiratory diseases are expected, the exact pattern of when many conditions will present is impossible to predict. Influenza is a good example of this.
Figure 3: Rates of presentation of influenza-like illness (ILI) to primary care
The figure above shows the consultation rate for influenza like illness (ILI) in RCGP RSC practices in the years 2004 to 2014. Rates were much higher in the swine flu pandemic of 2009 and the subsequent winter of 2010/11. The 2009 peak occurred ‘out of season’ in week 29 (13-19 July), though the 2010/11 peak fits with the usual seasonal circulation of influenza.
Ongoing increase in workload
Infectious diseases remain important in primary care. However, across a range of infections, rates of presentation to primary care appear to have increased over the last 10 years in RCGP RSC data. Acute respiratory disease presentations are also on the increase. Most acute respiratory diseases are infections, but some are not, for example asthma. There has generally be an upward trend in respiratory disease presentation over the last 10 years.
Figure 4: Weekly presentation to RCGP research and surveillance practices with acute respiratory illnesses
The black line is the weekly rate of acute respiratory infections showing the winter peaks. The blue line is the 10-year trend line with confidence intervals in grey. New presentations with respiratory disease to RCGP RSC practices has slowly and steadily increased over the last 10 years. The mean rate of increase is around 15 consultations per 100,000 registered per week. Whilst immunisation has been extremely successful across a range of diseases, consultations with GPs continue to rise.
In summary, if you thought that infectious and allergic disease results in less consultations for contemporary general practice, think again!
Find out more about this and other research databases and networks at the RCGP annual Conference, during “Practice, networks and research databases”, 2pm Friday 2 October 2015, Concurrent session E.
Session Chair: Simon de Lusignan,
Professor of Primary Care & Clinical Informatics, Medical Director, The RCGP Research Surveillance Centre
Hear from Matt Hoghton about “RCGP Research Ready®, assuring quality in general practice research”
RCGP Research Ready® is a quality framework supporting GP practices throughout the UK in their research activities. With a network of approximately 1000 practices RCGP Research Ready® helps practices to know, understand and meet the legal requirements of research. Accreditation is through an on-line self assessment process.
Richard Pebody will talk about “Universal paediatric influenza vaccination – early experiences and the contribution of the RCGP to programme evaluation”
The phased introduction of a new universal paediatric influenza vaccination across the UK began in 2013-14 following a recommendation from the Joint Committee of Vaccination and Immunisation.
Gillian Smith presents “Syndromic surveillance – use of real-time syndromic data (including RCGP data) for public health - ‘snippets’ from the last year”
Syndromic surveillance data (including GP consultations) collected and analysed in real-time can be used to inform about acute public health incidents and seasonal infections.