Improving continuity of care: analysis and advice from The Health Foundation

Research from The Health Foundation has shown that seeing the same GP leads to fewer hospital admissions. What can practices do to better understand the level of continuity of care that existing patients experience and what steps can they consider taking to improve continuity of care? Sarah Deeny, assistant director of data analytics at The Health Foundation, explores

The days of one GP providing care to a patient throughout their life may feel like a by-gone era; today practices can struggle to ensure that patients see the same GP consistently. The question is: does this matter?

The research

Studies show that there is a link between continuity of care – seeing the same GP more often – and patient satisfaction and 80% of general practitioners have stated that it is one of the most essential components of general practice. Continuity of care has also been shown to be linked to better adherence to medication and fewer visits to A&E.

Analysis undertaken by the Health Foundation looked at the link between continuity of care and hospital admissions for older patients in England, specifically in conditions that could be prevented through effective treatment in primary care. We found that if patients saw ‘their most frequently seen GP’ two more times out of every 10 consultations, this was associated with a six per cent decrease in hospital admissions.

In recent years there seems to have been a decline in continuity of care in England. In the 2017 GP Patient Survey the proportion of patients who reported being able to see their preferred GP fell from 42% in 2012 to 35% in 2016.

Possible reasons include:

• Changes to the GP workforce, more of whom are working part-time, developing specialisms, or taking on other responsibilities.
• Successive governments implementing policies to improve the speed of access to primary care. Reducing continuity of care is not an inevitable consequence of increasing access, but such interventions may have contributed to its fall.
• A growth in the size and scale of general practices. While there is some evidence that larger practices are better able to maintain good quality care there is also evidence that patients are concerned about losing their relationship with their trusted GP, and prefer smaller practices.

What, then, can hard-pressed practice managers do to help improve continuity of care?

• Receptionists and practice booking systems are central to promoting continuity. Prompts during the booking process could encourage appointments to be made with a patient’s usual GP.
• Large practices could consider organising themselves into small teams so that a subset of patients receive continuous care at a team level.
• Practices and commissioners could work together to identify specific patients who are experiencing low continuity of care and then ensure appointments are offered with their usual GP.

What have we learnt about how to effectively make improvements in areas like continuity of care?

It’s crucial to give GPs, whole practice teams and patients the skills and opportunities to identify where improvement is required and then to implement and evaluate changes.

GPs and practice teams may need support to analyse and use their own data to improve the quality of care. When practices develop their own solutions, it allows them to take ownership of changes and improve the morale and confidence of practice teams.

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