The work of the consultation in general practice: a comparison of affluent and deprived areas of Scotland using a novel consultation workload index.

Background: The workload within general practitioner (GP) consultations, and how this varies by deprivation, is not well known.

Aim: To examine how deprivation influences GP consultation workload by developing and applying a novel consultation workload index (CWI).

Design & setting: Secondary analysis of a cross-sectional postal survey of patients who had recently consulted a GP in deprived and affluent areas of Scotland.

Method: The CWI was developed using patient-reported data on: (1) whether more than one problem was discussed in the consultation; (2) whether a complex problem (defined as involving both physical and psychosocial issues) was discussed; and (3) the presence of a disability or limiting long-term condition. Results were analysed by area-level deprivation and consultation modality (face-to-face versus telephone).

Results: Analysis included 721 patients. Correlations between the three variables of the CWI were low (rho<0.2), suggesting that each was capturing a distinct aspect of consultation workload. Using the CWI, over half of all consultations in deprived areas had 'high' (25%) or 'very high' (29%) workload, compared with around a quarter in affluent areas ('high' 20%, 'very high' 6%). This was evident across both face-to-face and telephone consultations.

Conclusion: Greater patient need and complexity in deprived areas is reflected in higher GP workload in the consultation as measured by the CWI. Ways of operationalising the CWI routinely, for example through real-time AI analysis of consultations, should be explored, and if robust, could be used to inform the resource allocation to general to help address the inverse care law.