Reasons for Encounter (RFE) and Outcomes - A Snapshot of 2 UK Inner City General Practices

Problem

There have been studies linking deprivation to increased demand on health services. However, there are no UK based studies that delve specifically into why these patients present and how they are managed in primary care. This audit aimed to determine the range and prevalence of reasons for encounter (RFE) to GPs in an inner city general practice, the setting in which the encounter took place, and the outcome.

Approach

An audit of GP consultations was carried out in two GP Practices in Tower Hamlets, east London, by two 4th Year medical students. The practices are in a multi-ethnic deprived inner city area, with a combined list size of 15,122. Data was collected by examining read codes and clinical case notes review on EMIS for all patients seen from 4 randomly selected days in 2014/15.

Findings

There were 825 patients seen by 29 GPs, with a total of 1030 coded RFE. 70.0% of patients were seen in clinic, whilst 21.7% of patients had a telephone consultation. Patients had on average 1.28 coded issues at each encounter, with patients seen in clinic having relatively high coded RFE (1.32) than those dealt with on the phone (1.07).The top 5 coded categories were General/Unspecified 13.5%, musculoskeletal 13.2%, Digestive 12.4%, Respiratory 12.3% and Skin 9.8%. The most common specific RFE included cough 5%, health maintenance/prevention 4.5%, back symptoms/problems 3.3%, investigation results 3% and abdominal pain/cramps 2.7%.

1101 consultation outcomes were recorded, with ‘Prescription’ being the most common (29.79%) followed by ‘Reassurance’ (19.80%). 9.54% of all consultations were referred, and 0.54% were admitted to hospital. Reassurance outcome was highest in children 0-3 (34%) and reduced with age to 10% in patients aged 80+. The top RFE with reassurance only as an outcome include 37.3% respiratory, general/unspecified 26.7%, psychological 24.1%, musculoskeletal 21.2%, skin 17.7% and digestive 14.8%. Referrals also increased with age, with 16% of patients aged 80+ being referred.

Consequences

This audit has highlighted how there are a significant proportion of consults which resulted in reassurance. This is especially the case with respiratory conditions such as simple coughs. The NHS and primary care are undergoing a funding ‘crisis’ with GP practices, particularly in socioeconomically deprived areas feeling the pressure more than ever. Understanding RFE in primary care could help practices and CCGs to redirect patients to either more appropriate self-care services or to other members of the primary care team.