Most GPs struggle with “frequent attenders”. While this group represents just 10 per cent of all patients, they take up as many as 50 per cent of appointments. Frequent attenders typically have complex and chronic health problems – and often both physical and mental health conditions.
Despite considerable research, we don’t yet know how best to help them. One review of programs designed for frequent attenders reported that some programs provided education about appropriate use of services, and some provided mental health support.Yet, none of these programs reduced frequency of GP attendance, or improved quality of life.
It seems clear that we need a new approach to understanding and helping people who attend their GP frequently. And psychologists believe loneliness may play a role in this issue.
Frequent attenders are more likely to be socially isolated, according to research: living alone, divorced, or a member of few social groups. We also know that loneliness is very strongly related to poor health. Indeed, being lonely is a better predictor of premature death than physical inactivity or obesity. For lonely people, their general practitioner may represent one of the few ways of connecting with another person who listens to them and tries to help. In other words, it may be that unmet social needs are an important cause of frequent GP attendance.
We tested this idea in three studies with almost 1900 people. The first study was a sample of patients from five general practices in Scotland and we used GP records of physical health, such as Body Mass Index, blood pressure, and number of prescription medications. We found that lonely people – those with few social group connections – were more likely to be frequent attenders, even after accounting for their physical health, their age, gender, and socioeconomic status. Similar results were found in the second study which examined international students in their first semester of study in a new country. Over a four-month period, lower social group connections related to higher frequency of GP appointments, regardless of changes in students’ mental health.
In the third study, we piloted a social intervention, where frequent attenders were supported to join a social group and followed-up three months later. After joining a social group, 41 per cent of people visited their GP less often – and overall, people attended an average of about 1 appointment less every 2 months. This was, in part, because joining a social group was associated with improved wellbeing. However, there was also a direct effect – people who felt less lonely after joining a group experienced the biggest drop in GP attendance.
Our research suggests that there would be benefit to screening for loneliness in primary care and referring those who need it to a social group program that interests them: an approach known as social prescribing. The evidence in support of social prescribing is growing and this approach is being promoted in the UK by the new Minister for Loneliness. Social interventions have potential to reduce the burden on traditional health care both indirectly – by improving health – and indirectly – by addressing unmet social needs.