GP continuity of care could reduce workload in practices and A&E, potentially freeing up appointments, new research has found.
Researchers analysed data from more than 200 practices in England and found that continuity of care resulted in fewer follow-up appointments, both in practices and in A&E departments.
Looking at the Clinical Practice Research Datalink, which contains anonymised data from 222 practices spanning 2015 to 2017, the study found that patients who saw the same GP regularly had a longer time before their next consultation (an average of 61 days, compared with 56 for any other GP), meaning fewer consultations were needed in the practice.
The study, published in the British Journal of General Practice, also found that patients seeing their regular GP were ‘less likely’ (22% for non-regular GPs and 30% for locums) to attend emergency departments in the same week, and were also ‘significantly more likely’ to be referred to a specialist.
Antibiotic prescription was used as a marker for acute consultations with regression models to calculate risks for emergency department consultations and admissions, outpatient referrals, and test ordering, as well as the patients’ GP reconsultation interval following consultations.
The researchers said: ‘After adjustment, consultations with antibiotic prescriptions with regular GPs with continuity were associated with fewer subsequent hospital admissions and lower emergency department use but higher outpatient referrals relative to locums and non-regular GPs.
‘Locums ordered tests less often than regular GPs whereas non-regular GPs ordered tests more often.
‘Patients seeing their regular GP had on average a 9% longer reconsultation interval than if they saw any other GP.
‘Seeing a GP with whom the patient had continuity of care was associated with reduced workload within the practice and in hospital.’
The study was conducted by Cambridge Judge Business School, University of Cambridge, the University of Exeter Medical School and St Leonard’s Practice in Exeter.
Cambridge Judge Business School’s Professor Stefan Scholtes said: ‘We know that patients are having difficulties in getting GP appointments, and we’re seeing long waiting times at A&E departments.
‘It’s encouraging that this research shows that if general practices help patients to see their regular GP more often, fewer consultations and attendances at emergency departments are needed overall.
‘Making efforts for patients to see the same GP regularly could help patients by reducing pressure in both general practices and emergency departments.’
Professor Philip Evans, from the University of Exeter and the St Leonard’s Research Practice, said that their previous research has indicated that seeing the same GP regularly is linked to ‘numerous patient benefits’, including fewer hospitalisations and risk of death, and better care for people with dementia.
‘At a time when workload is probably the biggest problem facing general practices, it’s promising to find a research-based way of working which can reduce overall practice workload,’ he added.
RCGP chair Professor Kamila Hawthorne said the study is further evidence that continuity of care has ‘beneficial consequences for the entire health service’.
She said: ‘However, while GPs will strive to provide continuity wherever they possibly can, the sad fact is that it has become increasingly difficult to deliver due to intense workforce pressures.
‘Continuity allows us to build a trusting relationship with our patients, particularly those with complex health needs who need frequent treatment.
‘Seeing the same patient on multiple occasions gives us a greater holistic picture of their overall health, which can make taking preventative measures easier, allowing us to treat conditions before they have a chance to develop.
‘As the study suggests, this can keep patients out of secondary and emergency care – where it is more expensive to deliver treatment – and means patients are treated closer to home where they want to be cared for.’
It comes after the Department of Health and Social Care (DHSC) recently promised that its proposed changes to the GP contract for 2025/26 mean patients will ‘experience greater continuity of care’.
Last summer, health secretary Wes Streeting said GP practices would be given incentives to offer patients continuity of care, indicating that poorer performing practices would receive less money.
And last year Labour promised to remove ‘burdensome’ bureaucracy from GPs, but asked for better continuity of care in return.
NHS England had also hinted before Labour’s election win that continuity of care may be included in future contracts, but sought to assure GPs that this wouldn’t come with ‘silly measures and boxes to tick’.
Last year, a study found that continuity of care increases productivity in general practice by reducing demand for GP consultations.
Continuity of care used to be the whole point of general practice . With a small practice and a few Doctors it was pretty easy to achieve. Now with huge practices with 12 to 20 Doctors it is impossible. Most young people aren’t bothered and most young Doctors aren’t either . With good notes it’s not a necessity but would be nice . In the 41 years I have worked I have tried to maintain continuity in my practice , arranging follow up appointments either face to face or by phone . It’s pretty straightforward. All the other shite gets in the way of continuity .
Agree Rob. It is a pity that this study only ‘suggests’ a benefit – giving the impression that it is such a small benefit that it was hardly noticeable and not worthwhile. I am surprised that there was not significant previous research showing definitively that continuity bequeaths a high level of benefit to health and to efficiency, since this has been a ‘known’ for many years in general Practice.
“New research”. Oh dear.