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A cross-sectional analysis of staffing, activity, and patient need in general practice in England in 2023: a retrospective cohort study
Abstract
Background:
General practice in England is experiencing rising demand, workforce diversification, and widening health inequalities. However, there is limited empirical evidence describing how general practice activity is distributed across staff roles, patient complexity, and socioeconomic deprivation.
Aim:
To quantify patterns of general practice activity in England in 2023 by staff role, patient need group, activity category, and socioeconomic deprivation. Design and Setting: Retrospective cohort study using linked electronic health records from the Clinical Practice Research Datalink (CPRD) Aurum and Hospital Episode Statistics in England.
Methods:
A random sample of 1,000,000 patients registered on 1 January 2023 was followed for one year. Patients were assigned to Patient Need Groups (PNGs) using the Johns Hopkins Adjusted Clinical Groups system. Events were classified as consultation, clinical non-consultation, or administrative activity across 28 activity subcategories, and attributed to high-level categories of staff roles. Event rates per patient-year were calculated. Age- and gender-standardised rates were estimated across deprivation deciles. Results: Among 999,967 included patients, 24.2 million events were recorded (6.7 million consultation, 8.8 million clinical non-consultation, 8.7 million administrative events). Activity rose steeply with increasing clinical complexity; patients in higher clinical need groups had over four times more consultation events and seven times more clinical non-consultation events than low-need adults. GPs delivered the majority of clinically accountable activity, while multidisciplinary clinical staff contributed substantially to planned and protocol-driven care. After adjustment for age and gender, patients in the most deprived areas had higher rates of prescribing, referrals, fit notes, and administrative activity, but lower rates of preventative care.
Conclusion:
General practice workload rises sharply with multimorbidity and socioeconomic deprivation. Despite workforce expansion, doctors remain central to clinically complex and accountable care. Current funding and workforce models may not adequately reflect the higher intensity and inequality-related workload borne by practices serving more socioeconomically deprived populations.
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