CPD: Providing continuity of care
Dr David Turner is a GP in Hertfordshire
Key points
- Evidence shows continuity of care leads to better health outcomes and greater job satisfaction for GPs, but multidisciplinary teams in primary care and higher patient demand have eroded continuity
- Review your levels of continuity using available audit tools and patient satisfaction surveys
- Put continuity on the agenda for regular practice and MDT meetings
- New models of continuity are evolving – consider different models for different patient groups
- Care homes are a setting where different approaches can be tried and fine-tuned
- Where GPs work part time, consider a job-share approach where two doctors share a list
- Be aware of the downsides of continuity, such as longer waits to see a particular GP
Continuity of care has traditionally been easy to define – patients being able to see the same GP each time they attend the practice.
There is a wealth of evidence that shows continuity of care leads to better health outcomes for patients who get to see ‘their GP’, in terms of fewer hospital admissions, better adherence to prescribed medications, improved community care and lower rates of mortality.
This is especially true for vulnerable groups: very elderly patients; patients with multimorbidity or complex medical conditions; people with mental health problems; individuals with substance dependency; homeless patients and those who have experienced domestic abuse.
For GPs, continuity of care has other advantages, including patients being more likely to follow their advice and forgive moderate mistakes, as well as greater job satisfaction in the form of knowing their patients (something that secondary care doctors might not experience).
But in recent years, barriers have sprung up. The emergence of multidisciplinary teams in primary care has led to a complete change in the makeup of the GP surgery. Previously there would have been doctors, a nurse or two, receptionists and a practice manager. Now the team might include a pharmacist, nurse practitioner, physician associate, physiotherapist, paramedic and others.
Traditional continuity of care has been further eroded by increasing patient demand, an ever-ageing population, GPs leaving the profession or reducing their working commitment, and the rise in remote consulting since the Covid-19 pandemic.
But continuity of care is not extinct – it has just changed. Its definition has expanded to include continuity through an episode of illness, or continuity in the type of care provided, or continuity provided by a team and not an individual. These new models are evolving, and are likely to have similar advantages to the traditional ‘psychodynamic model’ we are used to.
Here are steps you can take to provide continuity of care in the new general practice landscape.
1: Audit your current level of care continuity
It may be that you are already providing a high level of continuity in the traditional sense. There are tools that allow you to measure this – the ‘usual provider of care’, which looks over a long term; and the St Leonard’s index of continuity of care, which takes data from practice systems.
If you want to review continuity without these tools, you may want to make a rough estimate of what percentage of home visits, face-to-face, phone call and video consultations the practice has been providing, and what percentage of patients in each of these categories had contact with the same practitioner.
Conduct patient satisfaction surveys to find out what patients think of your access arrangements and continuity of care to help identify patient groups whose needs are not being fully met with your appointment system.
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