Continuity of care more ‘productive’ than access-driven GP models, study suggests

Continuity of care increases productivity in general practice by reducing demand for GP consultations, a new study has suggested. 

The findings indicated that when patients see their regular GP, the time to their next visit is extended by around 18%.

Researchers at the University of Cambridge analysed data from over 10 million appointments in 381 GP practices over an 11-year period. 

They estimated that the total consultation demand in their sample could have fallen by 5% if all practices offered the same level of continuity of care as the top 10% of practices.

This boost to productivity was ‘particularly pronounced’ for patients with more complex needs such as older patients, those with chronic diseases, or those with mental health conditions. 

Based on their findings, the authors advised against models of care which prioritise fast access, and instead urged GP practices to focus on continuity of care. 

In the face of workforce challenges and high demand, they said primary care can either ‘industrialise primary care’ by scaling it up to maximise the number of consultations per day, or they can make continuity of care the ‘main goal’. 

The authors concluded: ‘Our findings suggest that practice managers who emphasise daily throughput and fast access should pause and reflect whether this strategy harms continuity and is counter-productive, as it harms the physicians’ productivity and generates avoidable demand for future consultations. 

‘In fact, doubling down on continuity can be an effective strategy to improve productivity, with positive financial implications, in particular if a practice operates in a capitation-based funding environment.’

Currently in North West London, GP leaders have raised ‘immense’ concerns about their ICB’s plans to effectively mandate the use of same-day access hubs. 

One of the principal concerns is that the hubs will erode personalised care and continuity of care by removing same-day work from individual GP practices. 

Co-author Professor Stefan Scholtes from the Cambridge Judge Business School said he is a ‘big believer’ in thinking at scale in primary care, but said the study’s data reveal a ‘problem’ with urgent care taking precedence over continuity of care.

Professor Scholtes told Pulse the study does not advocate for separating same-day care from longer-term term care, and he said it ‘would be a mistake’ to do so ‘organisationally’, for example with ICBs running all urgent care from treatment centres.

‘Practices need to use scale to provide the urgent care better but they need to make it in such a way that it’s still a team-based, site-based continuity of care approach to primary care,’ Professor Scholtes added.

For each consultation, the study authors identified the patient’s regular doctor as the doctor they had seen the most over the previous two years. 

They then analysed whether the time up to the patient’s next GP visit differed based on whether they had seen their regular GP or another doctor at the practice. 

This provided evidence that ‘consultations between a patient and a primary care physician are more productive if the physician is familiar with the patient’. 

Professor Scholtes said this impact is ‘substantial’ and ‘could be the equivalent of increasing the GP workforce by five percent’.

He also said GPs whose practices focus on continuity of care may have a ‘larger incentive’ to take more time to treat patients than a ‘transactional provider’ would. 

In response to the study, Oxfordshire GP Dr Rachel Ward, speaking on behalf of the Rebuild General Practice campaign, said ‘having the same GP across a lifetime’ is better for both patients and the NHS, and that being ‘family doctor’ is the reason she became a GP.

She said: ‘Continuity of care has been the foundation of general practice – but decades of neglect means there are not enough doctors to meet patient demand.

‘We have been raising the alarm about this for years and successive governments have failed to act. We need urgent investment in general practice to help us retain our doctors, so that we can give our patients the life-long continuity of care they deserve.’

In November, an independent safety investigations body recommended that the GP contract includes an ‘essential requirement’ for GP practices to ensure continuity of care. 

The Government is currently asking the public whether continuity of care should be an incentive as part of the Quality and Outcomes Framework (QOF) in its consultation on the future of the scheme.

The Labour Party has pledged to remove ‘burdensome’ GP bureaucracy in return for delivering continuity of care.

In August last year, shadow health secretary Wes Streeting said he wants to give GP practices financial incentives to let patients see the same doctor every time.