Seeing same GP reduces hospital admissions for older patients

Continuity of care in general practice is associated with fewer hospital admissions among older patients, researchers have found.

Improved continuity of care could form ‘a key line of defence against rising hospital admissions’, according to a study published in the BMJ.

The study says that patients who saw 'the same general practitioner a greater proportion of the time experienced fewer admissions' - suggesting that a link between patients and a specific GP, rather than simply a wider team, has a significant impact on care.

Continuity of care among elderly patients reduced hospital admissions for ambulatory care sensitive conditions - those that could be managed in primary care - such as asthma, diabetes, influenza and pneumonia.

GP access

The researchers, from charity The Health Foundation, warned that the government’s focus on improving access to primary care could be undermining continuity of care and inadvertently driving up hospital admissions - the exact opposite of what extended access was intended to achieve.

Data from over 230,000 records for patients in England aged 62 to 82 between 2011 and 2013 show that patients with ‘high’ continuity of care had over 12% fewer admissions for ambulatory care sensitive conditions than patients with ‘low’ continuity of care.

Patients with ‘medium’ continuity experienced an average of 9% fewer hospital admissions for these conditions.

The researchers concluded that continuity of care could ‘promote a more effective and trusting relationship between patients and doctors’, allowing them to better understand their health problems and the most appropriate way to treat them.

The findings suggest it could also reduce hospital pressures and improve GP job satisfaction, they added.

Continuity of care

Practices were incentivised to allocate a named GP with lead responsibility for each patient on their list aged over 75 from 2014, and required to allocate a named GP for every patient from April 2016.

But the latest research comes as evidence suggests practices' ability to maintain continuity of care is declining in England. Patient satisfaction surveys show that although most patients satisfaction with continuity of care remains high, falling numbers of patients who have a preferred GP report being able to see them all or most of the time.

RCGP chair Professor Helen Stokes-Lampard said the findings were further proof that the government must enact on promises laid out in the GP Forward View.

‘The relationship that GPs have with their patients is unique, and in many cases built over time – today’s study shows that this continuity of care can lead to both better health outcomes for patients, and reduced healthcare costs because of fewer hospital admissions,’ she said.

‘But delivering continuity of care is becoming increasingly difficult as GPs and our teams struggle to deal with increased patient demand, with fewer resources, and not enough GPs or practice staff.

‘We desperately need the government to deliver the pledges in NHS England’s GP Forward View to increase investment in general practice and significantly expand the GP workforce, so that family doctors and our teams can continue to deliver high quality patient care for years to come.’

A DH spokesman said: ‘This government is committed to making sure patients can get the right care at the right time from well-resourced GPs and from April 2015, all patients have had the right to continuity of care through a named GP, as part of the GP contract. This remains a key part of our plan to reduce pressure on hospitals, and is in no way diminished by extending access.’

Photo: Si Barber

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