Summary Background: Despite the well-documented clinical benefits of longitudinal doctor-patient continuity in primary care, rates have declined. An assessment by practice or health commissioners is rarely carried out. Aim: Using the Usual Care Provider (UPC) score, this study measures continuity in 126 practices in the mobile, multi-ethnic population of East London, comparing these scores with the General Practice Patient Survey (GPPS) response to the questions about GP continuity. Design and environment: A retrospective cross-sectional study in 126 practices in three east London boroughs. Method: The study population included patients who consulted three or more times between January 2017 and December 2018. Anonymised demographic and consultation data from the electronic health record were linked to the results of Q10 of the General Practice Patient Survey ( GPPS) of 2019. Results: The mean UPC score for the 126 practices was 0.52 (range 0.32 to 0.93). There was a strong correlation between practice UPC scores measured in the two years to December 2018 and responses to the 2019 GPPS question on “seeing the doctor you prefer,” Pearson’s r correlation coefficient, 0.62. Smaller practices had higher scores. Multilevel analysis showed greater continuity for patients older than 60 years compared to children and younger adults (ẞ coefficient 0.082, 95% CI: 0.080 to 0.084) and for women. Conclusion: It is possible to measure continuity across all practices in a local health economy. Periodic review of practice continuity rates can support efforts to increase continuity within practice teams. This is likely to have positive effects on clinical outcomes and satisfaction of both patients and physicians. |
Comments
The people who benefit most from seeing the same GP are those with long- term health problems and people who visit an office frequently. With continuity of care declining, these patients could be disproportionately affected, leading to suboptimal care and missed important problems.
Researchers are calling on policymakers to measure continuity of care as a marker of the quality of GP practice, with incentives to encourage improvement.
Continuity of care between GPs and patients leads to better outcomes for patients, particularly for older people, who have complex, long-term or multiple conditions, or poor mental health.
Research shows that patients who see the same doctor for most of their care have fewer hospital admissions and lower mortality rates.
Patients who frequently see the same GP are also more likely to establish a trusting relationship with them, follow advice and take preventive measures to improve their health. Despite its benefits, health policy does not currently measure or incentivize continuity, but the Health and Social Care Committee has made continuity of care a focus of its research into the future of General Practice.
Researchers from Queen Mary ’s Clinical Effectiveness Group (CEG) analyzed the care of 1 million adults registered in 126 GP practices in east London and found that half (52%) of patients regularly visit the GP GP. They found that patient age and practice size were the strongest predictors of continuity: the older the patient, the more likely they were to see the same GP; the greater the practice, the less likely.
Continuity of care has steadily declined , for reasons including the expansion of larger practices, an increase in the number of GPs working part-time, recruitment difficulties and a prioritization of rapid access over continuity. The pandemic has amplified many of these factors and changed the way patients interact with their local practice.
The Queen Mary study shows that it is possible to measure continuity of care in a simple way. The researchers used data from two sources, the Annual General Practice Patient Survey (GPPS) and the Usual Care Provider Index (UPC), to measure continuity of care in east London. This information is already collected routinely.
Queen Mary researchers are calling on policymakers to measure continuity of care as an indicator of practice quality. They hope the Health and Social Care Committee will consider this as part of the recommendations of its current inquiry into the future of general practice.
Dr Sally Hull, lead author and clinical reader in primary care development at Queen Mary University of London, said: “Continuity of care leads to better outcomes, particularly for older patients and those with complex needs. , and should be routinely measured as an indicator of practice quality. “We have shown that it is possible to measure continuity in a simple way, across an entire health economy, using information that is already routinely collected.”
Improving continuity of care will require incentivization and engagement of emerging primary care networks and integrated care systems. There are also opportunities for local initiatives, such as the development of micro-teams within larger practices, or changes to booking systems, but these should be supported by reliable monitoring.
With incentivization and monitoring in place, it is possible to improve continuity of care. In addition to improving clinical outcomes, this is likely to have a positive effect on both patient and physician satisfaction. “We hope that the Health and Social Care Committee will consider this in its current inquiry into the future of general practice.”
