Background The COVID-19 pandemic has had a significant impact on primary care service delivery. With general practice delivering record numbers of appointments and rising concerns around access, funding and staffing in the UK National Health Service, we assessed contemporary trends in consultation rate and mode (face-to-face versus remote). Methods We did a retrospective analysis of 9,429,919 consultations by GP, nurse or other health care professional between March 2018 and February 2022 for patients registered at 397 English general practices. We used routine electronic health records from Clinical Practice Research Datalink Aurum with linkage to national datasets. Negative binomial models were used to predict consultation rates and modes (remote versus face-to-face) by age, sex, and socio-economic deprivation. Findings Overall consultation rates increased by 15% from 4.92 in 2018-19 to 5.66 in 2021-22 with some fluctuation during the start of the pandemic. Consultation rates increased with deprivation. The breakdown into face-to-face and remote consultations shows that the pandemic precipitated a rapid increase in remote consultations across all groups but varies by age. Socioeconomic differences in consultation rate, adjusted for sex and age, halved during the pandemic (from 0.36 to 0.18 more consultations in the most deprived). The most deprived saw a relatively larger increase in remote and decrease in face-to-face consultations rates. Interpretation Substantial increases in consultation rates imply increased pressure on general practice. The narrowing of consultation rates between deprivation quintiles is cause for concern, given ample evidence that health needs are greater in more deprived areas. Funding No external funding.

MB declares no competing interests. JL works for NHS England's Digital First Primary Care team advising on evaluation and research in digital health and primary care. JL is contracted to this role as a NHS digital transformation consultant. EV, KDC, LZ and GC work for the Improvement Analytics Unit (IAU). This is a partnership between NHS England and the Health Foundation. The IAU evaluate complex initiatives in health care in order to support learning and improvement. The IAU is funded jointly by NHSE and the Health Foundation with funding assigned to jointly agreed priorities.

No external funding was received

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Ethics approval Clinical Practice Research Datalink (CPRD): CPRD has broad National Research Ethics Service Committee ethics approval for purely observational research using the primary care data and established data linkages. The study has been reviewed and approved by CPRD's Independent Scientific Advisory Committee (protocol number: 21_000357)

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Data is available from CPRD but restrictions apply to the availability of this data which was used under license for the current study.