'Chunking' patient lists boosts continuity of care, says GP super-partnership

Large practices can improve their continuity of care and reduce GP workload by having their patient list 'chunked' into smaller groups of between 3,500 - 5,000 patients, a GP super-partnership has found.

Consultation (Photo: iStock/SolStock)
Consultation (Photo: iStock/SolStock)

The Modality partnership, which serves around 400,000 patients nationally, took part in NHS England's vanguard programme testing new models of care. The group found that, by introducing teams within practices who were dedicated to smaller groups of patients within a practice list, continuity of care was ‘markedly improved’ - saving GPs thousands of hours’ worth of work.

The approach has been noted by Dr Nigel Watson - the senior GP leading an independent review commissioned by the government to revitalise the GP partnership model. Earlier this month, he wrote in a blog for GPonline: ‘It is interesting to see some large partnerships are forming smaller teams within their practices to try to ensure they deliver continuity of care.’

Dr Mina Gupta, GP and Modality partnership group clinical chair, said: ‘Continuity of care is improved by larger practices having their patient list chunked down into smaller groups of between 3,500-5,000 patients, meaning that patients are seen consistently by that same group of staff. This means in a practice where there are around 25,000 patients we have five teams dedicated to no more than 5,000 patients… Naturally, this means that the patients who attend their practice will then be seen by the same cohort of staff.’

Continuity of care

An independent evaluation of Modality’s work undertaken by the University of Birmingham and Nuffield Trust, published last year, found that the vast majority of staff at the partnership reported that having GP-led teams responsible for defined populations of around 3,500-5,000 patients led to reported improvements in patient access, continuity of care and signposting. Analysis also estimated that the model saved around 6,300 hours of GP time over an 18-month period.

Earlier this year, research from the University of Exeter found continuity of care was directly linked with lower levels of mortality.

Dr Watson told GPonline that the Modality model ‘shows how adaptable general practice is and how the model is evolving’.

‘We know that continuity of care is important for patients and also for GPs, but [we are] having to balance that against access,’ Dr Watson said. ‘There are advantages to being a small practice but there are also disadvantages, likewise being a super-partnership has some advantages but concern has been expressed about the loss of continuity and the team being too big. Modality and others are addressing this by creating smaller teams within their larger organisation.’

At Modality, smaller primary care teams include staff members at all levels - from receptionists and administrators through to nurses, healthcare assistants and GPs. Other roles, such as musculo-skeletal practitioners, physician associates and clinical pharmacists are shared across teams depending on practice size.

Small practices

Modality's approach follows the publication this summer of official data showing that small practices covering populations similar to the 'chunks' its staff are working with are disappearing fast.

Dr Peter Swinyard, national chairman of the Family Doctor Association, said that smaller practices have been working with this kind of model for years ‘very much to the benefit of patients’.

‘I think there is great mileage in working in small teams,’ he said.  ‘We know that if you achieve continuity of care - which means more than 60% of contact with the same person - then you actually genuinely reduce morbidity, you reduce hospital admissions and you reduce costs… It’s a virtuous circle - there really is very little to be said against it.’

Dr Swinyard said that although it is becoming increasingly difficult for small practices to survive in their current form, it was vital that the values they represent were recognised on a larger scale.

‘I think we should do everything in our power to try and persuade those who don’t understand to go and look at where [this type of model] is working well and to try and replicate it.’

Dr Gupta added: ‘As we continue to grow; we work with practices that join us to spread and share these positive learnings and support larger practices to implement these redesign approaches. We hope that the introduction of these methods to support smaller teams within practices that have large list sizes will continue to improve continuity of care, an overall holistic style and in turn improve patient satisfaction too.’

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