TOPLINE:

The consultation workload index (CWI) applied to general practices showed a higher GP workload in deprived areas of Scotland, with over 50% of consultations rated as those with a high or very high workload. Deprivation significantly affected consultation workload, especially for telephone consultations.

METHODOLOGY:

• Researchers conducted a secondary analysis of a cross-sectional survey (2022) involving patients from Scotland to assess differences in GP consultation workload between deprived and affluent urban areas.
• A total of 12 general practices in Scotland were selected to represent diverse geographic and socioeconomic characteristics, with the analysis comparing consultation workload in affluent and that in deprived areas, considering both face-to-face and telephone consultations.
• Patients reported the number and types of problems discussed during consultation, with complex issues involving physical and psychosocial elements.
• A novel CWI was developed using patient-reported data considering disability or limiting long-term illness, multiple problems, and the complexity of the problem discussed to quantify consultation workload on the basis of scores, with higher scores indicating a higher workload.
• Responses from 448 patients from urban-deprived and 273 from urban-affluent areas were included in the analysis (mean age of respondents, 62 years; 58% women).

TAKEAWAY:

• Correlations between CWI components were weak.
• The CWI revealed that 54% of consultations in deprived areas vs 26% of those in affluent areas were classified as those with a high or very high workload. Consultations deemed having a "low workload" occurred more frequently in affluent areas than in deprived areas (38% vs 15%).
• Telephone consultations in deprived areas had a high workload compared with those in affluent areas, with 51% vs 19% rated as those with a high or very high workload. Only 14% of telephone consultations in deprived areas vs 45% of those in affluent areas were considered those with a low workload.
• Face-to-face consultations in deprived areas also showed high or very high workload levels compared with those in affluent areas (58% vs 31%); however, those with a low workload were less common in deprived vs affluent areas (13% vs 33%).

IN PRACTICE:

"[The study] findings highlight limitations of current general practice funding models in the UK and underscore the need for tools that better reflect the true burden of general practice in deprived areas. Wider use of tools like the CWI could support more equitable service delivery and contribute to addressing the persistent effects of the inverse care law," the authors wrote.

SOURCE:

This study was led by Kieran D. Sweeney, MBChB, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland. It was published online on October 08, 2025, in BJGP Open.

LIMITATIONS:

The CWI cannot be easily applied to electronic medical records due to the lack of routine coding of problem types. This study did not account for practices with a "one problem, one consultation" policy, which could have affected workload assessments.

DISCLOSURES:

This study was supported by a grant from the Economic and Social Research Council. One author received funding from the Wellcome Trust Multimorbidity PhD Programme for Health Professionals. Another author received funding from the NHS Education for Scotland. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.