Abstract
Increased relationship continuity in primary care is associated with better health outcomes, greater patient satisfaction, and fewer hospital admissions. Greater socioeconomic deprivation is associated with lower levels of continuity, as well as poorer health outcomes. To investigate whether deprivation scores predicted variations in the decline over time of patient-perceived relationship continuity of care, after adjustment for practice organisational and population factors. An observational study in 6243 primary care practices with more than one GP, in England, using a longitudinal multilevel linear model, 2012-2017 inclusive. Patient-perceived relationship continuity was calculated using two questions from the GP Patient Survey. The effect of deprivation on the linear slope of continuity over time was modelled, adjusting for nine confounding variables (practice population and organisational factors). Clustering of measurements within general practices was adjusted for by using a random intercepts and random slopes model. Descriptive statistics and univariable analyses were also undertaken. Relationship continuity declined by 27.5% between 2012 and 2017, and at all deprivation levels. Deprivation scores from 2012 did not predict variations in the decline of relationship continuity at practice level, after accounting for the effects of organisational and population confounding variables, which themselves did not predict, or weakly predicted with very small effect sizes, the decline of continuity. Cross-sectionally, continuity and deprivation were negatively correlated within each year. The decline in relationship continuity of care has been marked and widespread. Measures to maximise continuity will need to be feasible for individual practices with diverse population and organisational characteristics.
Highlights
Relationship continuity declined by 27.5% between 2012 and 2017, and at all deprivation levels
Halting the persistent and widespread decline of continuity of care is a challenge for English general practices.[1]
Existing data were published as spreadsheets by Public Health England (PHE), NHS England, NHS Digital, and the Department of Health.[1]
Summary
Halting the persistent and widespread decline of continuity of care is a challenge for English general practices.[1]. The benefits of increased relationship continuity include a more holistic approach to care,[8] better recognition of some health problems,[9] better concordance with medication regimens,[10] better uptake of preventive services,[11] and more costeffective use of healthcare resources,[12,13,14] including reduced hospital admission rates.[15] the potential harms of continuity include increased staff costs to deliver,[2] potential collusion with less adherence to professional standards and guidelines,[16,17] and a lack of a fresh perspective[8] that may cause diagnostic delay.[18,19]. Increased relationship continuity in primary care is associated with better health outcomes, greater patient satisfaction, and fewer hospital admissions. Greater socioeconomic deprivation is associated with lower levels of continuity, as well as poorer health outcomes
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