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Analysis: A continuity of care target may not be the answer

Professor George Freeman, whose research formed the basis for the FDA’s ‘continuity of care allowance’ proposals, explains why he believes in the idea but has reservations on its widespread application

Access targets work against continuity and it is right for the Family Doctor Association to say that a continuity target will balance that. However, targets are concerning in themselves as they tend to be perverse.

The implications of this conflict could be worked out by a genuine pilot for the ‘continuity of care allowance’. But waiting three years for this may be unpopular.

The FDA’s proposed 60% target is ‘longitudinal continuity’, which is measured by a usual provider continuity index (UPCI). Although research has suggested that between 60% and 65% continuity may be the ideal, it is very high for a target across the board.

And measuring continuity is not as simple as it may seem. We have several computer systems in our practices and the way contact between GP and patient is recorded varies.

Some may not record whether a contact was a true face-to-face consultation or merely administrative – a prescription, a brief remark on the phone. These things can generate an entry in the narrative record and it can look like a contact in some systems.

So comparisons are more effective within practices than between practices and a pilot should assess this.

What is important is that we do not force continuity but we should make more opportunities to make relationships. Seeing the same person isn’t necessarily the same thing as having a genuine, therapeutic relationship. It’s the quality of the contact that really counts.

Professor George Freeman is a former GP and emeritus professor of general practice at Imperial College London

Readers' comments (2)

  • What is continuity? No one can be available every single moment. I am a GP and a patient. I do not expect to see the same person every single time and sometimes it is good to get another perspective. What does all this mean and how does it fit in with EWTD?

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  • Harry Longman

    Hear hear. Continuity is highly valued by GPs and patients - but not all the time (our evidence shows rise from 20% consults with children to 60% with over 70s). Multiple factors affect continuity and to build it into a target will have all the perverse outcomes we have seen everywhere else with the use of targets. Some GPs by the way are achieving over 80% continuity - the point is to design for it, measure it and improve it.

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