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Length of GP-patient relationship determines hospital use, study finds

Patients who establish longer relationships with GPs are less likely to require outpatient hospital treatment, a major primary care study has shown.

The researchers found that the probability of visiting outpatient specialist services was consistently lower for patients who had a relationship with their GP for over two years.

The study backed changes in policy to encourage greater continuity of care with GPs as a way of achieving greater savings in hospital care.

The Norwegian study, published in the British Journal of General Practice this month, looked at data over one year for more than 10,600 patients in primary care. Patients were split into two groups according to whether they had a relationship with their GP for over two years or two years or less.

They found that duration of the GP-patient relationship was consistently linked to the use of outpatient specialist services, independent of health and age. The group with a GP-patient relationship of less than or equal to two years had a rate of 541 per 1,000 with at least one outpatient specialist visit. This was higher than the group with a GP-patient relationship of greater than two years, with a rate of 486 per 1,000.

The researchers concluded: ‘Even if these associations are not proof of causality, GPs, specialist healthcare providers, health administrators, and policymakers who wish to limit use of specialist care may do well to perform and organise health services in ways that support continuity in general practice.’

The findings support a previous study that showed continuity of GP care was associated with reduced hospitalisations.

Professor Chris Salisbury, professor of primary health care at the University of Bristol and a GP in the city, said personal continuity of care was already an “endangered species” in some GP practices.

He said: ‘We need policy changes to incentivise continuity, otherwise it loses out in the face of other competing incentives.’

Dr Sarah Purdy, a reader in primary health care at the University of Bristol and a GP in the city, said the study backed US research that showed continuity of care was associated with decreased unplanned hospital admissions.

‘We don’t know what impact the continuity of GP care has in the UK. Providing solid evidence would provide more ammunition for us to lobby policy makers.

‘This has to be a good thing and I think that patients are likely to be great supporters of it too.’

Readers' comments (4)

  • And yet we consistently prioritise "access", mostly for minor self limiting illnesses over continuity of care.
    Telling people to wait & see their own GP is not really a big vote winner among the worried well!!

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  • Harry Longman

    Another paper, agreeing with the Richard Baker study published a year ago, different measure of continuity, but same link with lower referral rate.
    GPs want continuity, patients want continuity and it's good for resource use too. So yes we need policies which encourage it.
    But what we have found is that far from being opposed to access, it actually goes hand in hand. When access is easy, patients can choose which GP to see - they may only care in half of consultations, but those ones matter. When access is difficult, they tend not to have a choice and will see anyone available. There's then a rate of rebooking to see the preferred GP, increasing demand. So we we can see continuity not as a luxury, but a necessity.

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  • I agree, patient develop trust in their gp's over the years and follow the advice given. i worked as single handed and patients always listen to me. now i work as locum and as they never saw me before may not be sure of my decision for their care. continuity of care is in primary care is the biggest benefit we have.

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  • Hadrian Moss

    That is why we run personal lists in my six partner practice

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