Weather, the World Cup and bank holidays ‘affect GP appointment demand’

The weather, the football World Cup and public holidays all impact on the numbers of patients booking GP appointments, research suggests.

Colder, wetter weather, major health stories in the media and the periods following public holidays were all linked to an increased demand for same-day appointments.

Days of warm, sunny weather, international football matches and snowfall saw reduced patient numbers, the UK study found.

The authors say their data could help dozens of practices manage resources and staffing more intelligently to ensure primary care continues providing high-quality service amid rising demand.

Doctors at Clarendon Lodge Medical Practice in Leamington Spa have been implementing changes based on their findings since June 2018, and have reduced their annual locum costs as a result.

It is one of 5-10% of practices that are part of the GP Direct scheme, which sees patients given same-day telephone consultations followed by appointments in person if necessary later that day, rather than pre-booked slots.

Figures were obtained retrospectively from the surgery from September 2017 to September 2018, alongside Met Office weather data, major health stories and sporting dates from the BBC website.

The surgery, which has around 13,500 patients, reported that 44,885 appointments were booked during the study period – an average of 180 per day.

On the days of World Cup football matches, there was a significant decrease in demand, suggesting people “will prioritise watching the football game over arranging a GP appointment”.

Demand fell 16% on the days the England team was playing and 5% if it was not.

They found no link between events such as the Tour de France and international cricket.

Snowy weather saw a 16% reduced demand, which the authors suggest may have been due to difficulties in reaching the surgery.

Dr Hussain Al-Zubaidi, one of the researchers and a GP partner at Clarendon Lodge Medical Practice, told the PA news agency: “Having the same staff meeting different demand just doesn’t work.

“And often that’s the case, in a lot of GP surgeries, they have got the same team managing a very different workload day to day, and that leads to the problems we are having with recruitment.

“Because often you’ll get those days that are extremely busy, they’ll put a strain on their staff but if we can predict that and put in measures to try to prevent it… we will get locums and that locum will mean something, whereas in the past sometimes we will get locums potentially thinking it will be busy, and we’re not fully utilising that resource.

“So we are trying to prevent waste essentially.”

The study also found that prominent news stories “greatly affected” the number of appointments booked, particularly reports relating to cancer, mental health, paediatrics and flu.

On days cancer stories were published, uptake increased by 9%.

They wrote: “Articles relating to cancer, in particular, showed marked spikes in patient appointment demand, potentially highlighting specific symptoms that the patient was either unaware of or overlooking.

“Furthermore, they often discuss cases where the cancer was missed or mistreated and often request the patient to contact their GP if they had any concerns, which may have contributed to the increased demand observed.”

Previous international research has shown a link between external events and emergency department admissions but the link to primary care demand had not been explored.

The practice is now using the data to predict when demand for services is likely to peak or when quieter days are likely.

They adjust staffing levels according to predicted demand and schedule resource-heavy activities, such as staff meetings, six-week baby checks, steroid injections and minor operations, for quieter days.

And the practice has seen its locum costs reduce more than £25,000 in the year after implementation (September 2018- August 2019), compared with the year before.

The authors wrote: “Forecasting tools have been grossly underused to assist GP practices to predict future demand. Although forecasting tools based on weather projections are being utilised to manage health on a national level, there is currently little to no exposure on a local level.

“With the ever-increasing threat of climate change, understanding how weather impacts patient demand will be crucial to prepare primary care for the future.”

Professor Martin Marshall, chairman of the Royal College of GPs (RCGPs), said: “Understanding trends in demand is vital in order to plan when and where resources are needed most, not just in general practice but right across the NHS, but they are not always easy to predict.

“Sporting events, for example, are infrequent and as this research shows can have a variable impact – and realistically, GPs can only ever really plan for the impact of news stories after they are in the public domain. But even the weather is becoming more unpredictable.”

He added: “Reliable forecasting tools would be useful – and it’s interesting to see how this practice is taking this forward – but traditionally, we haven’t had the same access to accurate data as secondary care colleagues, which has made planning difficult.

“The RCGP already collects data through our Research and Surveillance Centre on what conditions we are seeing in general practice and we work with Public Health England to use this for this for flu planning – and we’re starting to collect workload data with the intention of using it to help GPs proactively plan for demand changes.”