GP continuity of care has dropped sharply this decade, study warns

Levels of continuity of care delivered by general practice in England have fallen by more than 25% in just six years, a study has found.

Continuity of care fell by a total of 27.5% from 2012 to 2017, according to the study published in the British Journal of General Practice (BJGP), which analysed responses to the national GP patient survey. Researchers looked at responses from patients who said they had a preferred GP across 6,243 practices, and assessed how frequently they were able to see that GP.

Study authors described the decline in continuity of care as ‘persistent and widespread’, suggesting that doctor-patient relationships could be suffering due to increased workload and other related problems such as longer wait times for appointments.

The contractual requirement for patients to have a named GP, which began in 2016, does not seem to have slowed decreasing continuity levels, the study found.

GPC chair Dr Richard Vautrey said: ‘Continuity of care is at the heart of good general practice and it frustrates GPs that over the last 10 to 15 years the focus has been more on immediate access rather than investing in developing longer-term continuity. This has been seen most recently with the development of a variety of online GP services.’

Continuity of care

Research published in 2017 showed that patients aged over 65 with poor continuity of care in general practice were more than twice as likely to face an emergency hospital admission as patients who had high continuity of care.

Dr Vautrey added: ‘As more people live longer with more long-term conditions, the economic and clinical need to refocus on continuity with a stable practice team is all the more important. That’s why it’s vital that the government provides the necessary recurrent investment to give practices the stability they need and to enable an expansion of the practice team to be able to offer greater continuity of care.’

RCGP vice chair Professor Kamila Hawthorne said: 'Continuity of care is at the heart of general practice and is highly valued by both patients and GPs alike - in fact, 80% of UK family doctors say it is one of the most essential components of general practice. We also know it can lead to better health outcomes for patients, and helps keep the NHS sustainable due to fewer hospital admissions.

'Continuity of care can be particularly beneficial for the growing number of patients who are living with multiple, long-term conditions. But unfortunately, it is becoming harder and harder to deliver as GPs and our teams work under incredibly intense resource and workforce pressures.'

Patient experience

The report also found that continuity of care was 'moderately correlated with good overall experiences for patients.

'This is in line with what we know about continuity being associated with higher patient satisfaction and greater patient trust,' Professor Hawthorne said. 'It's disappointing but understandable to read that, according to this paper, continuity of care is reducing, but GPs across the country are striving to provide continuity, even if not in the traditional sense.'

The RCGP has produced a continuity toolkit to help practices measure and improve the level of continuity of care they provide. However, the study concluded that without more funding for general practice it is likely that continuity levels will not improve.

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