GP continuity of care could ‘effectively disappear’ unless action taken

GP continuity of care could ‘effectively disappear’ in England unless decisive action is taken now, warn researchers who have tracked its ongoing decline.

A study led by the University of Leicester looking at data from 6,010 general practices found the national average of continuity of care, as measured through patient survey data, fell from 29.3% to 19% between 2018 and 2022.

The analysis showed the decline happened in all types of practices and became steeper after the pandemic.

They also found that rate of decline was not associated with deprivation, whether the practice was urban or rural, its size, or now many nurses it employed.

Slower declines in continuity were seen in practices with more doctors and with higher percentages of patients seen on the same day as booking.

Yet it declined more quickly in practices where continuity had previously been better, where there were higher percentages of patients of White ethnicity, or practices located in many areas outside of London, they reported in the Annals of Family Medicine.

Overall the findings suggest that the decline in continuity has been exacerbated by both the pandemic and fewer GP appointments being available as practices come under increasing pressure.

It follows a previous study by the same team which showed a marked decline in longitudinal continuity of care between 2012 and 2017.

The drop in continuity of care has coincided with decreasing patient satisfaction in general practice, the team noted.

More research is now needed on possible associations between continuity and appointment uptake, workforce mix and the impact of the pandemic, the researchers said.

Other studies have linked continuity with reduced patient mortality, better care for patients with several chronic diseases as well as better job satisfaction for GPs.

Labour has confirmed to Pulse that in order to fulfil its commitment to ‘bring back the family doctor’ and offer GP continuity of care where patients want this, it would a bring in a financial incentive for practices should they win the general election next week.

Speaking with Pulse, Dr Steven Levene from the Department of Population Health Sciences at the University of Leicester, who led the study, said there was a risk that continuity could become ‘extremely uncommon’.

‘If you’re going to try and reverse the trend, you need to understand what might be driving it down and the decline is fairly widespread,’ he said.

Their analysis found that broadly speaking continuity declined more quickly in practices where there were fewer GPs per patient population and where a lower proportion of patients were able to get appointments on the day.

‘Both those factors are linked to appointment availability so that might be one of the things that drives the decline in continuity,’ he added.

In terms of levers that might encourage the trend to reverse he said small changes across everyone could have a substantial effect at a population level.

‘You want to support as many practices as possible to be in a position to achieve better continuity, which comes back to appointments and increasing capacity. That may be looking at what the current workloads are, is everything that practices are doing the best use of their time, making the best use of non-medical staff and I think you do also have to look at incentives.’

As a starting point, practices may also want to look at providing continuity to those who would most benefit before expanding that out as well as thinking ‘more imaginatively’ about how you deliver continuity where staff are working less than full time. 

‘The disappearance of continuity of care should not be inevitable. By prompt effective nationwide action to help practices provide enough appointments and prioritise continuity more within appointment systems, and to remedy shortages of GPs in many practices, the NHS might be able to halt and then reverse this worrying trend,’ he said.