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Boosting GP continuity of care ‘could save millions’

Experts have urged commissioners to design GP services around the principle of continuity of care, after a new analysis showed that it could have a substantial effect on reducing costs from hospital admissions.

The research from the University of Leicester estimates a 1% increase in continuity of care over a year could save £20,000 per GP practice, and urges commissioners to design services to protect continuity.

Previous studies have shown reductions in emergency admissions, but this new analysis shows even a small increases in the proportion of patients able to see a particular GP could cut up to eight elective admissions per year per practice.

The research – published last month in the Journal of Public Health - looked at patient survey scores from GP practices in two PCTs – Leicester City and Leicestershire County and Rutland – from 2006/7 and 2007/8.

They then compared them with admissions data and found practices with a higher male population, and those in which more patients were able to see a specific GP, were associated with lower rates of elective admissions.

A 1% increase in the proportion of patients able to see a particular doctor was associated with a reduction of 7.6 elective admissions per year in the average-sized practice for 2006/07 and 3.1 elective admissions for 2007/08.

They calculated practices in the 2006/7 sample would save £20,000 on average through a 1% increase in the proportion of patients able to see a specific GP.

The findings raise questions about the NHS Outcomes Framework, which compels commissioners to improve access to primary care services and boost ‘patient experience of primary care', but does not contain any requirement to ensure continuity of care.

Study leader Professor Richard Baker, professor of quality in healthcare at the University of Leicester, said: ‘The weight of evidence is sufficient to justify the avoidance of initiatives in primary care that reduce continuity and of evaluations of interventions to improve continuity.'

Professor Martin Roland, a professor of health services research at the University of Cambridge and a GP in the city, said the research was part of a body of evidence that was being ignored by the Department of Health.

He said:  ‘This Government doesn't understand the importance of continuity. They and the last government have had a strong focus on improving access, at the expense of continuity of care. But both should be valued equally.'

Dr Malcolm Kendrick, a GP in Macclesfield, Cheshire, agreed, but said continuity across the NHS was becoming much more difficult as the number of providers increases.

He said: ‘We need more integration between GP care, social care and other services to provide continuity as a support network.'

A Department of Health spokesperson said: ‘We recognise that continuity of care can contribute to better patient outcomes.'

‘We are about to begin piloting new arrangement for patients to register with the most convenient practice that is likely to provide much greater overall continuity of care.'

 

Continuity of care, in numbers

7.6 – reduction in elective admissions per year for a 1% increase in continuity

 £20,000 – savings per year for a 1% increase in continuity

£2,641 – cost per hospital admission

0 – number of indicators for continuity of care in NHS Outcomes Framework 2013/14

Source: J Pub Health 2012, online 23 March

http://jpubhealth.oxfordjournals.org/content/early/2012/03/23/pubmed.fds024.full.pdf+html

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