Discussion
The purpose of this study was the one to define FA, or HU, in general practice, establishing an absolute minimum number of consultations in a given period of time.
Our results show that a threshold of 15 encounters per year can represent a very useful value to that purpose.
In the past, several absolute thresholds have been suggested. In Italy, for example, the criterion of absolute reference number has ranged from 2 to 24 contacts per year. The majority of the studies set the threshold between 9 and 14 annual visits, the frequency of which GP in Italy would be unanimous in defining FA.
In our study, it emerges how only 5% of the practice population has seen their GP 15 times or more in 1 year.
In addition, the 15 GP encounters seem to match with a sudden and strong increase of visit requests, so to be a good candidate to threshold value.
Although the number of FAs accounts for only 5% of the GP practice population, it does demand a very significant GP working time.
It is possible, but it was not the subject of study on this occasion, that the encounters could last longer than average.
More specifically, the standard 10-minute encounter adopted by most GPs in the United Kingdom may not suffice to deal with FA needs. Moreover, we did not question whether and how often the FAs are clinically studied with blood tests and imaging, or subject to referral to Secondary Care, compared to their peers.
Our results, contrary to previous work on the subject, do not suggest the need for greater specificity and sensitivity for the identification of the FA using smaller groups, dividing all patients into age-by-sex cohorts.
Unlike other studies, we have not excluded from the audit the subjects over 75 years and paediatric patients.
Interestingly, the prevalence FAs seems to diminish rather than increase in the very senior group compared to the group of 60-75 years throwing doubts about the linear relationship between fragility and medical complexity with the number of GP encounters, but also on the social reasons unleashing frequent GP attendances.
It is unlikely that the financial impact of FAs on the budget of the NHS is negligible.
Based on the cost ratio of sanitary and social units 2017 of the PSSRU at the University of Kent, the cost of a Single Surgery Encounter with the GP is estimated bee £38.00 (\euro 43.37; $53.55). The cost is higher for the Home Visit and it increased further by the cost of prescription, by the administrative costs, and the costs of the requests for specialist visits.
Therefore, since the average number of encounters per year per patient is 0.8, with some variability by age and gender range, and taking into account the fact that about 1/5 of the population of practice does not consult the GP during the entire 12-month period, the additional financial burden arising from FAs will start from a minimum of £555.00/year (\euro633.43; $782.18) per FA.
By extending this calculation to 5% of the UK population, the minimum additional expenditure The British National Healthcare System that can be attributed to FAs is £1.82 billion (\euro2.05 billion/$ 2.54 billion).
The magnitude of this figure, combined with the scarcity of human resources and recruitment problems in General Practice in the UK, is such that it would seem to urge to manage more effectively FAs. Their timely identification would therefore be an important starting point.