You might be left scratching your head after a long clinic with consecutive, complex consultations, an occurrence that feels increasingly common to me. I wrote recently on BJGP Life about the domino effect of unintentional consequences from the Additional Roles Reimbursement Scheme (ARRS), a complex intervention within a complex system. In their report, The Future of General Practice, the House of Commons Health and Social Care Committee (HSCC) suggested that the introduction of these new professionals into practice has left GPs dealing with multiple challenging cases ‘one after another’, which they cite as a contribution to clinician burnout, decision fatigue, and increasingly detrimental effects on patient safety. But do the ARRS roles lead to GP clinics filled with increasing complexity, and what are the other contributory factors?

Multimorbidity is common and is increasing, especially among an ageing demographic as in the UK. Recent projections suggest that, among people aged >65 years, more than 68% of the population will have more than two chronic medical conditions by 2035. GPs know that this ageing and increasingly multimorbid population is leading to increasingly complex work, usually without additional resources. But it is not just multimorbidity and ageing at play here. The catalogue of factors contributing to increasing consultation …