Persistent frequent attenders in primary care: Costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention

Richard Morriss, Joe Kai, Christopher Atha, Anthony Avery, Sara Bayes, Matthew Franklin, Tracey George, Marilyn James, Samuel Malins, Ruth McDonald, Shireen Patel, Michelle Stubley, Min Yang

Research output: Contribution to journalArticlepeer-review


Background: The top 3% of frequent attendance in primary care is associated with 15% of all appointments in primary care, a fivefold increase in hospital expenditure, and more mental disorder and functional somatic symptoms compared to normal attendance. Although often temporary if these rates of attendance last more than two years, they may become persistent (persistent frequent or regular attendance). However, there is no long-term study of the economic impact or clinical characteristics of regular attendance in primary care. Cognitive behaviour formulation and treatment (CBT) for regular attendance as a motivated behaviour may offer an understanding of the development, maintenance and treatment of regular attendance in the context of their health problems, cognitive processes and social context. Methods/design. A case control design will compare the clinical characteristics, patterns of health care use and economic costs over the last 10years of 100 regular attenders (30 appointments with general practitioner [GP] over 2years) with 100 normal attenders (6-22 appointments with GP over 2years), from purposefully selected primary care practices with differing organisation of care and patient demographics. Qualitative interviews with regular attending patients and practice staff will explore patient barriers, drivers and experiences of consultation, and organisation of care by practices with its challenges. Cognitive behaviour formulation analysed thematically will explore the development, maintenance and therapeutic opportunities for management in regular attenders. The feasibility, acceptability and utility of CBT for regular attendance will be examined. Discussion. The health care costs, clinical needs, patient motivation for consultation and organisation of care for persistent frequent or regular attendance in primary care will be explored to develop training and policies for service providers. CBT for regular attendance will be piloted with a view to developing this approach as part of a multifaceted intervention. © 2012 Morriss et al.; licensee BioMed Central Ltd.
Original languageEnglish
Article number39
JournalBMC Family Practice
Publication statusPublished - 2012


  • Cognitive behavior therapy
  • Health care economics and organizations
  • High utilisers of care
  • Hypochondriasis
  • Primary care
  • Somatoform disorders


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