• This briefing summarises research that analysed data from over 230,000 anonymised patient records for older people aged 62 - 82 years.
  • They found there were fewer hospital admissions for certain conditions when patients saw the same GP more consistently.
  • Patients seeing their usual GP two more times out of every 10 was associated with 6% fewer avoidable hospital admissions.

Download the briefing Reducing hospital admissions by improving continuity of care in general practice.

Key points

  • Continuity of care is an aspect of general practice valued by patients and GPs alike. However, it seems to be in decline in England.
  • Our analysis, published in The BMJ and summarised in this briefing, looks at the link between continuity of care and hospital admissions for older patients in England. We looked specifically at admissions for conditions that could potentially be prevented through effective treatment in primary care. 
  • We found there to be fewer hospital admissions – both elective and emergency – for these conditions for patients who experience higher continuity of care (ie those who see the same GP a greater proportion of the time). Controlling for patient characteristics, we estimate that if patients saw their most frequently seen GP two more times out of every 10 consultations, this would be associated with a 6% decrease in admissions. 
  • To improve continuity for patients, general practices who are not already doing so could set prompts on their booking systems and encourage receptionists to book patients to their usual GP. Patients could also be encouraged to request their usual GP.
  • Clinical commissioning groups and NHS England Area Teams could work with general practices to support quality improvement initiatives that maintain or improve continuity of care.
  • Future national initiatives should have a well developed understanding of how and why the policy will impact on continuity in a particular context. 

Comments

Gillian Seward



GPs are in short supply, and the extra promised will not be trained for some ears yet. Surely Community Matrons/Nurses are the people to maintain contact with patients with LTCs, referring to GP as necessary. In addition, the ability to see the Practice Nurse (who should be qualified to prescribe) with minor problems, when necessary. This would help lift the load off GPs.
I realise these measures may well be in place in some surgeries, but not all.



Derek Barron



We have employed an Advanced Nurse Practitioner working across two of our Care Homes - the ethos is the same - if we can get the same person to review/assess residents to a higher level we think we should be able to reduce A&E attendances, ergo less admissions.

We've got three weeks experience thus far, maybe a bit early to be conclusive on outcomes.



Krishna Radia



Sadly, we have burnt our bridges with continuity of care. The patients belonging to practice and not to a particular GP has ended the concept of continuity. The ending of OOH commitment of practices was the beginning of the end.

The problem solution has been attempted with extended hours and allocation of named GPs goes a little way towards addressing this.

The changes have gone too far to look at history. The only solution is to look at targetting care using the scarce "GP resource". The new workforce of GPs needs to be convinced of this and trained appropriately to look at the new way of working.



Andrew Mimnagh



I was chair of my local medical committee when the alternative contract PMS and APMS forms where brought in. I can rest content that the risk of lack of continuity of care was fully raised, the DOH cry was "where is the evidence" and there was none.
The state needs to be aware that " we hold these truths to be self evident" statements from a majority of medical staff are almost certainly eventually proven to be correct, and as the author of the comment above notes the damage done by the failure to listen is likely to be permanent.



Kassander



And who is to determine what constitutes 'minor problems', please?
In many cases, it is determined by one of the staff at Reception



Kassander



@ Gillian Seward 06 February 2017
One aspect which would "help lift the load off GPs." would be for those 1 000s who are involved in the work of CCGs to cease forthwith and use their well paid time to do the job they trained for = being a GP.



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