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GP continuity of care could ‘effectively disappear’ unless action taken

GP continuity of care could ‘effectively disappear’ unless action taken

GP continuity of care could ‘effectively disappear’ in England unless decisive action is taken now, warn researchers who have tracked its ongoing decline.

A study led by the University of Leicester looking at data from 6,010 general practices found the national average of continuity of care, as measured through patient survey data, fell from 29.3% to 19% between 2018 and 2022.

The analysis showed the decline happened in all types of practices and became steeper after the pandemic.

They also found that rate of decline was not associated with deprivation, whether the practice was urban or rural, its size, or now many nurses it employed.

Slower declines in continuity were seen in practices with more doctors and with higher percentages of patients seen on the same day as booking.

Yet it declined more quickly in practices where continuity had previously been better, where there were higher percentages of patients of White ethnicity, or practices located in many areas outside of London, they reported in the Annals of Family Medicine.

Overall the findings suggest that the decline in continuity has been exacerbated by both the pandemic and fewer GP appointments being available as practices come under increasing pressure.

It follows a previous study by the same team which showed a marked decline in longitudinal continuity of care between 2012 and 2017.

The drop in continuity of care has coincided with decreasing patient satisfaction in general practice, the team noted.

More research is now needed on possible associations between continuity and appointment uptake, workforce mix and the impact of the pandemic, the researchers said.

Other studies have linked continuity with reduced patient mortality, better care for patients with several chronic diseases as well as better job satisfaction for GPs.

Labour has confirmed to Pulse that in order to fulfil its commitment to ‘bring back the family doctor’ and offer GP continuity of care where patients want this, it would a bring in a financial incentive for practices should they win the general election next week.

Speaking with Pulse, Dr Steven Levene from the Department of Population Health Sciences at the University of Leicester, who led the study, said there was a risk that continuity could become ‘extremely uncommon’.

‘If you’re going to try and reverse the trend, you need to understand what might be driving it down and the decline is fairly widespread,’ he said.

Their analysis found that broadly speaking continuity declined more quickly in practices where there were fewer GPs per patient population and where a lower proportion of patients were able to get appointments on the day.

‘Both those factors are linked to appointment availability so that might be one of the things that drives the decline in continuity,’ he added.

In terms of levers that might encourage the trend to reverse he said small changes across everyone could have a substantial effect at a population level.

‘You want to support as many practices as possible to be in a position to achieve better continuity, which comes back to appointments and increasing capacity. That may be looking at what the current workloads are, is everything that practices are doing the best use of their time, making the best use of non-medical staff and I think you do also have to look at incentives.’

As a starting point, practices may also want to look at providing continuity to those who would most benefit before expanding that out as well as thinking ‘more imaginatively’ about how you deliver continuity where staff are working less than full time. 

‘The disappearance of continuity of care should not be inevitable. By prompt effective nationwide action to help practices provide enough appointments and prioritise continuity more within appointment systems, and to remedy shortages of GPs in many practices, the NHS might be able to halt and then reverse this worrying trend,’ he said.



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

Peter Jones 28 June, 2024 8:52 pm

No surprise when funding is directed away from actual GPs to the myriad of ‘additional roles’ and Pharmacy ( who are paid more per consultation with patients with the simplest problems than GPs who see the most complex presentations). Madness.

Liquorice Root- Bitter and Twisted. 28 June, 2024 8:55 pm

Access vs. continuity of care.
Make your choice?

Derval Damner 29 June, 2024 2:10 pm

Continuity of care is now a luxury that most
GP partnerships cannot afford to provide. Patient demand far exceeds GP supply, especially partners. Skill Mix, Working at Scale, Additional Roles, Hybrid working all contribute, but the underlying issue is the financial viability of General Practice. Until that’s fixed, continuity is not going to happen.

Jude the Obscure 29 June, 2024 7:31 pm

You cant have continuity if you want to micro manage every aspect of general practice. Gordon Brown brought in extended hours. Great. You can now see ‘your’ GP at 8pm…only it isn’t going to be ‘your’ GP sunshine because GPs are people just like you, they have families and lives and they cant all work till 8pm every night. They have to do a rota. Same thing for weekends…i’m sorry but you dont train for 10 years to become a GP to work every Saturday morning just because Tescos is open then too. General Practice is not a super market and its not acute/emergency care service. If you have an emergency go to A&E. If it isnt an emergency you can wait till Monday. Unless you want to actually FUND this shit. No? I didn’t think so. Want to save money and strip out all the ‘trivial stuff’ so GPs only see the complex ball aches? Ok but they’re going to get pretty knackered I’m afraid and they’ll need a day off more often. These people are humans. This stuff is heavy. You can only whip a horse so much before it dies. Plus forget continuity if the politician dictates your ‘trivial’ problem isn’t worthy of a GPs time..sorry you cant see one..they are too expensive and know too much. You don’t get quality on the NHS. Well if you are a politician not in primary care you don’t. And if you want half a GPs day to be taken up calling people in who don’t want to come in for QOF related checkups (which if they don’t do they wont get paid) don’t be surprised if the people who DO want to come in cant get an appointment. ALL this BULLSHIT was brought in in the last decade or so by MORONIC politicians (Like Gordon F’in Brown) so if you are looking for a reason why continuity has been destroyed in primary care look at Westminster and the IDIOTS in think tanks not GPs

Dr No 29 June, 2024 10:45 pm

Part-time working the main problem. I went to 4 clinical sessions rather than give up, and for me, it works. For my patients? Not so much. I’m in my late 50s now and better at what I do than I have ever been. I’m the one people want to see. Dr No spares the politics and profanity at work. But can I do high quality GP 5 days a week? 2 is the max. If HMG of whatever colour wants me back for 9 sessions a week… I can’t foresee any policy that would do that for me. Well, maybe ditch the micromanagement, revalidation, reduce daily intensity by 40% and give me a 25% pay uplift….

Yes Man 30 June, 2024 2:19 pm

Dr No u da man ( or woman )

Waseem Jerjes 30 June, 2024 4:13 pm

Continuity of care is at risk of vanishing in England unless immediate action is taken. The drop in GP availability and increased patient demand have strained the system. Without addressing the financial challenges in General Practice, true continuity remains out of reach.

Turn out The Lights 30 June, 2024 8:33 pm

Spot on Dr No,gone to 2 days a week myself and won’t be going back at any price

Jude the Obscure 1 July, 2024 10:43 am

Agree Dr No. You sum it up well

Andrew Jackson 2 July, 2024 12:02 pm

The pool of GPs that recognise that continuity of care is the relatively unmeasurable wonder of General Practice is diminishing to the point that there will be no-one left to advocate for it.
Continuity of care will return if we can have the ambition that it should be possible for a GP to have a long term F/T career if that is what they want and that those working longer time periods in a stable practice are the highest earning in our profession (instead of often the lowest).
Bring back seniority that can only be earned by doing surgeries and people will return to what they were trained for instead of often finding higher paid roles that avoid seeing patients.