Introduction: Demand for health care is rising everywhere, and resources are limited. Primary care has been no exception, with consequent morale and recruitment problems among GPs. It is beyond GPs to influence mass consulting behaviour, though public education programmes to encourage responsible use of GP services have been tried. However, surveys indicate that a small minority of frequent attenders (e.g. 2%) is responsible for 10% or more of total workload. Frequent attenders could thus be possible subjects for specific management, both to improve their health and to optimise resource use.

Objective: to review systematically randomised controlled trials on managing frequent attenders.

Methods: we searched for relevant trials on Medline, Psyclit and Embase, also consulting reference lists, reviews, experts, the Science Citation Index and the Cochrane Primary Care database.

Results: we found no trials of management strategies for unselected frequent attenders. We found four small trials relating to selected subgroups: two of psychiatric consultation and advice for those with distress / medically unexplained symptoms (one positive, one negative), one of group GP discussion treatment for frequently attending mothers with small children (positive), and one of a letter to frequent non-attenders (those who make frequent appointments and then do not arrive) (positive).

Discussion: Frequent attenders are an important minority in primary care, who may have unmet health needs, and major effects on resource use and staff morale. There is a lack of published trials on managing this important group. Two small trials indicated simple strategies of a GP letter and a GP discussion group might be worth further evaluation.