Barely a month goes by without a new study on the benefits of relational continuity in primary care. BMJ in Feb “Continuity of primary care and hospital admissions” concluding “An increase of 0.2 in the usual provider of care index for all patients was associated with a 6.22% reduction in admissions for ACS conditions”.
In short, GPs who know their patients well are better at keeping them out of hospital.
It’s one of those studies which seem self evident, like the one which found that having a box of chocolates within arm’s reach increased the consumption of chocolate, versus the control where they were out of reach. Someone had to do it.
The question is, how do you increase continuity, and can you have too much?
I’ve looked in detail at two large practices’ data this week with contrasting figures. In one, lack of continuity is clearly a problem, GPs concerned that their quality of care is suffering and interestingly more concerned than patients. (we have evidence that if it’s difficult to name a GP, patients give up trying).
In the other, continuity is a high priority and personal lists are strongly enforced. Yet there’s huge frustration among patients simply trying to book an appointment – wrong day, long wait and so on.
We know that continuity isn’t always a priority (imagine a patient presenting with acute pain and being told to wait two weeks until her GP is back from holiday). There seems to be a range between 30 and 50% of demand where GPs and patients agree it’s important.
Here are the top three tips and how we can help.
1. Make it a priority in the practice to measure continuity. Our GP Navigator analysis does it automatically.
2. Advertise everywhere which GPs are working which days. Patients who care will make their own continuity.
3. Let patients choose and try to meet their requests – it’s more efficient for you too, as there’s less rework. But don’t make it a trade off for a long wait, that’s why starting every day with a blank sheet improves access and continuity together.
It’s a process of continuous improvement.
PS Des Spence in Pulse, “Continuity is dead” – absolute rot. Ignoring the evidence will only result in patient harm.
PPS We’ve always encouraged practices to offer named clinicians on askmyGP. Concord practice in Bristol have broken the record for online submissions in launch week at 295, of which 23% chose to name a GP.