Population, workforce, and organisational characteristics affecting appointment rates in primary care: a retrospective cross-sectional analysis

Background
The recent publication of data on appointment volumes for all practices in England has enabled representative analysis of factors affecting appointment activity rates for the first time.

Aim
To identify population, workforce, and organisational predictors of practice variations in appointment volume.

Design and Setting
Cross-sectional analysis of 6,284 GP practices in England in August to October 2022.

Method
Multivariable regression analysis relating population age and deprivation, numbers of GPs, nurses and other care professionals and organisation characteristics, to numbers of appointments by staff type and to proportions of appointments on the same or next day after booking.

Results
Appointment levels were higher at practices serving rural areas. Practices serving more deprived populations had more appointments with other care professionals but not GPs. One additional full-time equivalent (FTE) GP was associated with an extra 175 appointments over three months. Additional FTEs of other staff types were associated with larger differences in appointment rates (367 appointments per additional nurse and 218 appointments per additional other care professional
over three months). There was evidence of substitution between staff types in appointment provision. Levels of staffing were not associated with proportions of same or next day appointments.

Conclusion
Higher staffing levels are associated with more appointment provision, but not speed of appointment availability. New information on activity levels shows evidence of substitution between GPs and other care professionals in appointment provision and demonstrates additional workload for practices serving deprived and rural areas.

Keywords
primary care, activity, consultations, access, deprivation, workforce

How this fits in
Supply and demand predictors of variation in activity levels for all practices in England could not be identified until now. We show that appointment rates per person are higher for practices serving rural areas. Appointment rates with other care professionals are higher in deprived areas but appointment rates with GPs are not. There is clear evidence of substitution between GPs and other care professionals in the provision of appointments.