'Life-saving' continuity of care at risk in the UK, GPs warn

Continuity of care in general practice reduces use of out-of-hours care, acute hospitalisations and mortality, researchers have shown - as GP leaders warned staff shortages and heavy workload means it is becoming harder to deliver in the UK.

GP consultations (Photo: Robert Johns/UNP)
GP consultations (Photo: Robert Johns/UNP)

Long-lasting personal continuity with a GP is 'strongly associated with reduced need for out-of-hours services, acute hospitalisations, and mortality', according to a study by researchers in Norway.

An association lasting more than 15 years between a patient and a specific GP reduces the probability of any of these factors by 25-30%, the study published in the British Journal of General Practice found.

The researchers said 'promoting stability among GPs' should be a priority for health authorities, and warned that continuity of care was under pressure.

Continuity of care

The findings come as general practice in the UK faces intense pressure amid a shortage of GPs and intense workload after more than 18 months of the COVID-19 pandemic.

Responding to the findings, RCGP chair Professor Martin Marshall said: 'Continuity of care is highly valued by patients and GPs and our teams alike. It is what allows us to build relationships with our patients, often over time, and this study builds the strong evidence base of its benefits for patients and the NHS.

'Delivering continuity of care is becoming increasingly difficult as GPs and our teams struggle to deal with intense workload and workforce pressures – and the need to prioritise access to GP services. However, GP teams strive to deliver continuity of care in innovative ways, such as working to build trusting relationships between different members of the practice team, not just the GP.'

Professor Marshall warned that building the GP workforce as a matter of urgency was vital - urging the government to 'make good on its promise of 6,000 more GPs and 26,000 more members of the practice team'.

GP workforce

Professor Marshall said: 'General practice urgently needs more GPs and more members of the practice team, but we also need more time with patients. This is why the college has long been calling for 15-minute appointments, at least, to be standard in general practice – but offering longer appointments means offering fewer, and swift access to services is already strained.

'Not all patients value continuity of care - but many, particularly those with complex health needs, do and this study demonstrates that it’s essential continuity of care remains at the forefront of general practice.'

The study used outcome data for patients recorded in 2018 and looked at frequency of GP visits and morbidity in the three preceding years, with weighting for factors including age, sex, ethnicity and rurality.

Lead author and senior researcher Hogne Sandvik at the National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, said: 'It can be life-saving to be treated by a doctor who knows you. If you lose a general practitioner you've had for more than 15 years, your risk of needing acute admission to hospital or dying increases considerably the following year.’

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