Measuring the complexity of general practice consultations: development and validation of a complexity measure

Chris Salisbury*, Sarah Lay-Flurrie, Clare R Bankhead, Alice Fuller, C Murphy, Barbara A Caddick, José M. Ordóñez-Mena, Tim A Holt, Brian D. Nicholson, Rafael Perera, F D Richard Hobbs

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

9 Citations (Scopus)
133 Downloads (Pure)


Background: The complexity of general practice consultations may be increasing and vary in different settings. Testing these hypotheses requires a measure of complexity.

Aim: To develop a valid measure of general practice consultation complexity applicable to routine medical records.

Design: Delphi study to select potential indicators of complexity followed by cross-sectional study to develop and validate a complexity measure.

Setting: English general practices.

Method: An online Delphi study over two rounds involved 32 general practitioners to identify potential indicators of consultation complexity. The cross-sectional study used an age-sex stratified random sample of 173,130 patients and 725,616 general practice face-to-face consultations from 2013/14 in the Clinical Practice Research Datalink. We explored independent relationships between each indicator and consultation duration using mixed effects regression models, and revalidated findings using data from 2017/18. We assessed the proportion of complex consultations in different age-sex groups.

Results: After two rounds, the Delphi panel endorsed 34 of 45 possible complexity indicators. In the cross-sectional study, after excluding factors because of low prevalence or confounding, 17 indicators were retained. Defining complexity as the presence of any of these factors, 308,370 consultations (42.5%) were complex. Mean duration of complex consultations was 10.49 minutes, compared to 9.64 minutes for non-complex consultations. The proportion of complex consultations was similar in men and women but increased with age.

Conclusion: Our consultation complexity measure has face and construct validity. It may be useful for research, management and policy, informing decisions about the range of resources needed in different practices.
Original languageEnglish
Number of pages21
JournalBritish Journal of General Practice
Early online date22 Dec 2020
Publication statusE-pub ahead of print - 22 Dec 2020


  • Clinical (general)
  • Diagnosis
  • International
  • Clinical (physical)
  • Cancer
  • Education and standards
  • Patient safety
  • Research methods
  • Epidemiology


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