Have the drivers of general practice appointment volumes changed as a result of the Covid-19 pandemic?

Problem

This paper aims to quantitatively identify the demand- and supply-side drivers of general practice appointment volumes, and investigate whether these have changed since the Covid-19 pandemic. Although the number of consultations was significantly reduced in the short run by lockdowns and other restrictions, consultation volumes may have increased in the long run due to the advancements driven by the pandemic, such as the implementation of remote consultation systems.

Approach

We conducted a panel data regression analysis of consultation volumes at the 106 Clinical Commissioning Groups (CCGs) in England over two periods of 22 months each, covering March 2018 to December 2019 and March 2021 to December 2022. The periods were chosen to avoid national lockdowns and have common seasonality in the pre- and post-covid periods. The monthly CCG-level numbers of attended appointments per registered patient were regressed against workforce composition and the proportion of patients over 65 using a fixed-effects panel data regression model.

Findings

In the period before the pandemic, the number of full-time equivalent GPs working in the CCG was the only significant predictor of appointment rates. A 1% increase in FTE GPs was associated with a 0.174% increase in appointments per patient. However, after the lockdowns, the main contributor to appointment rate changes was the proportion of registered patients that were over 65. A one percentage point increase in the proportion of patients over 65 was found to be associated with a 0.123% increase in the appointment rate.

Consequences

The results show that prior to pandemic appointments were mostly limited by staff supply, whereas after the lockdowns appointment rates were driven by patient factors. This may indicate that patients are more likely to get appointments when needed as the numbers of staff working in general practice have been increasing over the last 5 years. However, the inclusion of COVID vaccination appointments in the dataset may also explain this phenomenon as elderly patients are more likely to be targeted for vaccinations. Further research is required once more post-covid data that are not affected by vaccination programme becomes available.