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Independents' Day

Patients seeing the same GP ‘key to reducing hospital admissions’

Seeing the same GP more often is linked to fewer avoidable hospital admissions for illnesses that could have been dealt with in primary care, a large study of patients’ GP and hospital records has revealed.

Authors of the study, published in the BMJ, said their findings showed national policy makers should focus on improving ways for people see the same GP in order to reduce pressure on hospitals, while GP leaders said it supported their calls for investment in core general practice services rather than simply channelling efforts into increasing round-the-clock GP access.

For their study, academics from the Health Foundation analysed the patient records of over 230,000 older people, aged between 62 and 82 years, over a four-year period between April 2011 and March 2013.

They found that avoidable hospital admissions – for things like asthma, diabetes, flu and pneumonia that could really have been managed by a GP practice – were less frequent the more often people saw the same GP.

For each additional two out 10 visits that the patient was able to see their preferred GP, there were 6% fewer avoidable admissions.

And, for example, patients who saw their most regularly consulted GP at least seven times out of every 10 visits had 12% fewer avoidable admissions than those who saw them four times out of 10.

The association was even stronger amongst patients who were particularly heavy users of health care.

The researchers concluded: 'This study motivates a renewed focus on promoting continuity of care, and it suggests that continuity is an important consideration when designing approaches to reduce hospital admissions.'

The team noted that national policy has largely focused on improving access to primary care, for example, by extending opening hours or introducing remote care - which actually contributes to reducing continuity of care.

The study findings also call into question the Government’s commitment to get GP practices offer routine appointment seven days a week – even if this means patients seeing a GP from a neighbouring practice rather than their own – as a key solution to the crisis in over-loaded NHS hospitals.

Co-author Adam Steventon, director of data analytics at the Health Foundation, said: ‘This research is important because it shows that patients who more regularly see the same GP experience fewer admissions to hospital. Improving continuity of care is not just what patients and GPs want, it could also help to reduce pressure on hospitals.’

He added: ‘An ongoing relationship between patients and GPs is important. However, general practices are under considerable pressure, and people are finding it increasingly difficult to see their preferred GP. There are a number of national policy initiatives focussed on improving primary care – any future initiatives should not lose sight of the crucial role of continuity of care.’

Dr Richard Vautrey, deputy chair of the GPC, said the study 'provides further evidence of the importance and value of the long term relationship with patients that a GP practice can provide, which benefits not only individual patients but also the wider healthcare system'.

Dr Vautrey added: 'A recent BMA survey also highlighted how continuity of care was one of the elements of general practice that was most valued by GPs. It's why the BMA have consistently called for investment directly in to practices rather than funding separate and often fragmented access schemes.'

RCGP chair Professor Helen Stokes-Lampard said the study ‘shows that this continuity of care can lead to both better health outcomes for patients, and reduced healthcare costs because of fewer hospital admissions’.

But she added that ‘delivering continuity of care is becoming increasingly difficult as GPs and our teams struggle to deal with increased patient demand, with fewer resources, and not enough GPs or practice staff’.

BMJ 2017; available online 31 January

How Government attempts to cut hospital use through GPs have failed

The Government has recently been pushing its extended hours agenda as a solution to the unraveling crisis in NHS acute hospitals. Prime Minister Theresa May provoked anger by ordering GPs to open their doors seven days a week, telling national newspapers that practices were blame for the crisis because they were not opening during evenings and weekends.

However, there is little evidence that evening and weekend GP appointments impact on secondary care use. As Pulse reported, NHS England's own evaluation of the scheme showed seven-day opening made no impact whatsoever on emergency admissions.

Among other initiatives to help keep people out of hospital, health secretary Jeremy Hunt introduced a 'named GP' initiative to try to re-introduce better continuity of care but the approach failed to make any impact

And Pulse revealed that the bureaucratic 'unplanned admissions DES', which required practices to develop risk registers of vulnerable patients and oversee their care plans, has failed to reduce emergency activity in hospitals.

Readers' comments (17)

  • Finally some sense!! But how does this work with your 7 day opening Mr Hunt? It doesn't. Oh dear. Full circle

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  • It only works when your favourite gp works 7 days a week, 24/7, simples!
    Back to gold old Victorian slave labour, oh I forgot, this is 2017 and younger docs won't do it, the lazy so and so's

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  • 600 registered patients per GP is the ideal. Then continuity of care is possible. It worked when I was a GP in Canada. We had our own small hospital, admitted and looked after our patients. GPs and patients loved it. Income was massive. Should have remained, too old now.

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  • Lack of continuity combines with risk averse alternative health care practitioners- just watch the NHS collapse

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  • Stop press! Continuity of care works, we've know this for decades. It's therefore utter madness that the government are pushing us in the opposite direction 'working at scale' and federations. Perhaps they actually want to drive admissions upwards because it will be good for business when the NHS is sold off?

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  • errrr yes- so self evident but what is more to the point is that seeing the same gp who has known you a long time and is vastly clinically experienced makes it even less likely that you will be admitted to hospital which is why what i call the "somme generation" of gps, those between 55-65, who have been wiped out into premature retirement is such a disaster for the nhs.

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  • Healthy Cynic

    Advice to Government:

    Ditch the patient Choice agenda.

    Replace with Continuity agenda.

    Thus funding might find its way to where it is needed.

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  • Simple, PT working is no longer allowed!

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  • This study is refreshing but will almost certainly be buried as doesn't fit in with Government diktat. It would also now be practically impossible to implement because of the lack of GP numbers. Patients need to be more patient and be more prepared to wait for their preferred GP rather than opting to see the first available.

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  • It needs investment in general practice . Up to 12 % of the NHS budget say.

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