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GP contract should include ‘essential’ continuity of care requirement

GP contract should include ‘essential’ continuity of care requirement

A requirement for practices to ensure continuity of care should be included in the GP contract, an independent safety investigations body has recommended.

The Health Services Safety Investigations Body (HSSIB), an independent arm’s length body of the Department of Health which investigates patient safety concerns across the NHS, argued that this would improve patient safety ‘by building clinician–patient relationships’.

In its latest report, HSSIB said that making continuity of care an ‘essential requirement’ for GP practices could reduce the risk of a delay in diagnosing serious health conditions and ease pressure on GPs’ workload.

It also recommended that NHS England updates the GP IT standards to ensure continuity is maintained, including the identification and prioritisation of information when patients visit GP practices multiple times with ‘unresolving symptoms’.

RCGP vice chair Dr Victoria Tzortziou-Brown said that delivering continuity of care is becoming ‘increasingly difficult’ as GPs and their teams struggle with intense workforce pressures and patient need growing in both volume and complexity.

She also said that given current pressures, ‘it’s hard to see how such a requirement would be feasible for many practices’.

She said: ‘Continuity of care is highly valued by GPs and patients alike, particularly those patients with complex health needs.

‘It allows us to build trusting relationships with our patients, and this study highlights it has benefits for patients and the wider NHS.

‘But delivering continuity of care is becoming increasingly difficult as GPs and our teams struggle with intense workforce pressures and patient need growing in both volume and complexity.

‘GP teams across the country do strive to deliver continuity of care in innovative ways, in line with daily pressures and new ways of working; for example, by prioritising patients who would most benefit from continuity and fostering trusting relationships between patients and several members of our multi-disciplinary teams, including GPs.’

She added that there is ‘a huge amount of pressure’ on GPs to ‘prioritise quick access’ services over other important factors for patient care, such as continuity.

‘Making continuity of care a “requirement” is not straightforward, as it may mean different things to different practices and patients, and some patients may value it and benefit from it more than others,’ Dr Victoria Tzortziou-Brown added.

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‘As with any targets, there are also risks associated with taking an inflexible approach that could lead to unintended consequences.

‘What we do need to see is more resources for general practice and thousands more GPs and other members of the team, so that practices can ensure their patient populations can get the appropriate care they need.’

During their investigation, HSSIB spoke to a sample of patients and GPs from surgeries that did operate systems of continuity of care, as well as surgeries that don’t.

The report also reinforced that if any GP can access the relevant clinical history and information quickly, then it can help to ‘aid effective decision making in practices’.

However, HSSIB heard from many GPs that IT systems do not present information in a way that enables them to quickly see if a patient is returning with ‘unresolved symptoms’.

Neil Alexander, senior safety investigator at HSSIB said: ‘What struck our team during the investigation was the clear differences in patient experience and GP welfare between those practices that operate a model continuity of care and those that don’t.

‘We could see that all want to deliver the best care they can but the extreme pressure of workloads and having to prioritise other essential requirements makes it very difficult. 

‘Even though practices with systems could see benefits, they told us they had often implemented without proper frameworks, guidance, and explicit funding.

‘It became clear to us that in order for GP practices to be able to prioritise continuity of care in a consistent way, it must become part of the essential services they need to deliver.

‘Our findings and safety recommendations are a call to action to those at a national level, to help prevent the delayed diagnosis of serious health conditions, and ensure patients get safe and efficient care wherever they are in the country.’

Earlier this year, a survey of over 4,000 people in the UK has found the majority want to see the same GP every time they attend an appointment.

In August, the Labour party said it wants to give GP practices financial incentives to let patients see the same doctor every time, in a bid to boost continuity of care.

The recommendations

  • HSSIB recommends the Department of Health and Social Care ensures that the GP contract explicitly includes and supports the need for GP practices to deliver continuity of care. This is to improve patient safety by building clinician–patient relationships as well as providing continuity of information.
  • HSSIB recommends NHS England updates the GP IT standards to ensure patient continuity of care is maintained, including the identification and prioritisation (technically known as ‘clear surfacing’) of information to health and care professionals, when patients visit GP practices multiple times with unresolving symptoms.

Source: HSSIB


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Please note, only GPs are permitted to add comments to articles

kieron cooney 30 November, 2023 10:06 am

Highly valued and a great loss to my love of being a family doctor. Not valued by government priorities and interference and now workforce decimated so we have locums and non doctors in place of the family doctor who is on his knees struggling to keep the practice solvent … are they waking up to the legacy of 13 years of changes resulting in the current issues

Turn out The Lights 30 November, 2023 10:12 am

If they are waking up to the damage done it to late to reverse the direction of travel.The country has been bankrupted by the Tories.

David Church 30 November, 2023 10:23 am

Do we need to tell patients what is needed if they wish to retain an NHS at all, leave alone with continuity of care by fully-qualified Doctors? It may be considered a political step.

Michael Mullineux 30 November, 2023 10:32 am

Mutually exclusive contradictory muddled thinking as usual. Continuity of GP care vs mashup smorgasbord of instant access see anybody instantly with tons of irrelevant observational nonsense in records obscuring relevant clinical data. As always, I have complete faith in the chain of command …

Simon Gilbert 30 November, 2023 10:42 am

Patients: “I never get to see Dr X anymore”
Government: “Patients should always be able to see the same GP.”
Patients: “The waiting time to be seen is too long”
Government: “Patients should always be seen within 2 weeks.”
GPs: “This requires more funding”
Government: “Here is the funding so that all patients can see their preferred GPs within 2 weeks”
GPs: “What can we spend this funding on”
Government: “Anyone but GPs”

Patients: “Dr X has retired”
Government: “Get me Dr Merion Thomas stat to write an article shaming doctors who retire from the NHS. That should help!”

Simmering Frog 30 November, 2023 12:59 pm

The HSSIB is the new name for the Healthcare Safety Investigation Branch . The HSIB was so toxic it basically had to be renamed due to the culture of bullying and racism within it:

And don’t forget the old CEO claiming for helicopter flight lessons on the NHS:

I am a fan of continuity, and I think it helps greatly, but I will take the advice of this lot with a large grain of salt.

Reply moderated
Logged Out 30 November, 2023 5:08 pm

Mandating continuity of care on practices that face unmanageable workload could be the last straw.

SUBHASH BHATT 30 November, 2023 6:41 pm

Best continuity was offered by single handed gps. It is rare breed now. Group practices should allocate each gp their own list. Staff should book all patients with gp they are on list barring holidays and sick leave. Gps working part time should work 5 days at least as they have every night, weekend and bank holidays off. Limited availability generate so called extreme pressure.

Pommai Prasad 1 December, 2023 9:37 am

Very true!!!!
With the current crisis of recruitment and retention and shortage of GPs it is an idealistic dream.
Continuity of care should also be enforced in secondary care.
Decision makers should dismount from their high horses and experience the NHS real world.

David Banner 2 December, 2023 11:04 am

So they kill the GP geese then moan about the lack of eggs? Idiots.

Look, you had a system for decades where a doctor in their late 20s signed up for a GMS Practice for 30-40 years before handing it on to the next 20something successor.

But you didn’t like their power and inflexibility, so you set about slowly starving them out, replacing them with short-term malleable APMS surgeries.

Turns out that having portfolio-career, part-time, peripatetic doctors jumping ship every few years doesn’t give the same continuity of care that a boring old lifer stuck in the same old surgery for decades does.

Who’da thunk it? D’oh!!

If you’re serious about Continuity then start protecting and nurturing your remaining GMS Practices, and maybe swallow your pride and allow a few more to set up shop.

Otherwise, just shut up and go away. You caused the mess, clean it up yourselves.

BEVERLEY SCOWEN 4 December, 2023 7:55 pm

Hear Hear David Banner. Couldn’t have said it better myself. The likes of us have been banging on about how critically important continuity of care is in General Practice for decades. How is this suddenly news? What a complete waste of time and money this “body” is. I wonder how many hundreds of thousands of pounds of public funding was required for them to come up with this golden nugget. How long and how many more hundreds of thousands will it take them to work out that ship has long since sailed.