Abstract
BackgroundContinuity of care is a core principle of primary care related to improved patient outcomes and reduced healthcare costs. Evidence suggests continuity of care in England is declining.AimTo confirm reports of declining continuity of care, explore differences in decline according to practice characteristics, and examine associations between practice populations or appointment provision and changes in continuity of care.Design and settingLongitudinal design on GP Patient Survey data reported annually in June or July from 2012 to 2017, whereby the unit of analysis was English general practices that existed in 2012.MethodLinear univariable and bivariable multilevel models were used to determine decline in average annual percentage of patients having a preferred GP and seeing this GP ‘usually’ according to practicelevel continuity of care, rural/urban location, and deprivation. Associations between percentage of patients having a preferred GP or seeing this GP usually and patients’ experiences with the appointment system and practice population characteristics were modelled.ResultsIn 2012, 56.7% of patients had a preferred GP, which had declined by 9.4 percentage points (pp) (95% CI = −9.6 to −9.2) by 2017. Of patients with a preferred GP, 66.4% saw that GP ‘usually’ in 2012; this had declined by 9.7 pp (95% CI = −10.0 to −9.4) by 2017. This decline was visible in all types of practices, irrespective of baseline continuity, rural/urban location, or level of deprivation. At practice level, an increase over time in the percentage of patients reporting good overall experience of making appointments was associated with an increase in both the percentage of patients having a preferred GP and those able to see that GP ‘usually’.ConclusionPatients reported a steady decline in continuity of care over time, which should concern clinicians and policymakers. Ability of practices to offer patients a satisfactory appointment system could partly counteract this decline.
Highlights
Patients in England are registered at one general practice at which they can consult with any doctor or GP
In 2012, 56.7% of patients had a preferred GP, which had declined by 9.4 percentage points by 2017
Of patients with a preferred GP, 66.4% saw that GP ‘usually’ in 2012; this had declined by 9.7 pp by 2017
Summary
Continuity of care is highly valued by patients and GPs,[1] and linked with healthcare cost reduction[2] and improved patient outcomes,[3] such as patient satisfaction,[4] reduced emergency hospital admissions,[5,6] and reduced mortality.[7,8,9] some patients might benefit from a ‘fresh pair of eyes’[10] and seeing the same doctor increases waiting time,[3] in general, these disadvantages of continuity of care are outweighed by the benefits mentioned above; as such, it is important to monitor continuity of care. Continuity of care is a core principle of primary care related to improved patient outcomes and reduced healthcare costs.
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