Activity in the NHS

In total there were an estimated 570 million patient contacts with GP, community, mental health, hospital, NHS 111 and ambulance services in 2021/22. This is equivalent to every person in England being assessed, treated and cared for by the NHS 10 times a year, or 1.6 million interactions with patients every day.  

The largest volume of NHS activity is in primary care – people receiving services from their local GP practice. That could be in person, over the phone or online and with a GP or another member of the practice staff, such as a nurse or physiotherapist. In 2022 there were an estimated 329 million appointments in primary care.  In recent years there has been an increase in the proportion of GP appointments conducted by telephone, however in 2022 two-thirds of appointments were still face to face. 

Community health services also represent a large proportion of NHS activity, though the exact quantity is hard to estimate. This activity covers services such as visits from district nurses who carry out nursing duties such as wound care, medication administration and advice in a patient’s home. It also covers contacts with or visits from community-based allied health professionals, such as physiotherapists and occupational therapists, and health visitors who support children and their families from birth to five years old. It is difficult to obtain consistent and comprehensive national data for these services, but the best estimates suggest there were around 73 million interactions with patients in 2021/22.  

Activity in NHS hospitals has increased significantly over the past 10 years. Pre-pandemic, activity had been rising in accident and emergency departments and hospital inpatient services (eg, on-the-day surgery for a hip replacement or an overnight stay in hospital). But the fastest growth in activity had been for outpatient services (eg, follow-up with a consultant after a fracture). In 2021/22 there were 140 million patient interactions in hospital.

In 2021/22 there were an average of 27 calls every minute to the ambulance service and 44 calls every minute to NHS 111. NHS 111 received 10 million more calls in 2021/22 compared to when it was first fully rolled-out in 2014/15.

It is very hard to definitively define NHS activity so here we have largely focused on services commissioned and provided by the NHS. There is limited information on activity that is paid for by the NHS but provided by non-NHS providers, and work that is done by NHS hospitals for a fee, eg, private patient units. Data availability in some sectors, such as primary care and community health care, is getting better but is not as consistent as for the hospital sector.

These figures are for NHS services that are provided free at the point of use. If we included services where patients may be asked to contribute to the cost of their care, eg, dentistry, prescriptions or opticians’ appointments, the number of interactions would be significantly higher. Additionally, some NHS activity cannot currently be measured, eg, contacts with the 111 online service.

The work to support the estimate that the NHS sees a million people every 36 hours was undertaken more than 10 years ago. Using the methodology we have described, and with the caveats we have outlined, we estimate that NHS activity has increased to an average of 2.3 million interactions with patients every 36 hours, or a million interactions every 15 hours.