This project used data analysis to identify patients with new or changing symptoms who may benefit from continuity, and implemented operational systems that supported people to achieve continuity.
Increasing Continuity of Care in General Practice A programme to fund targeted quality improvement work to increase continuity in GP practices
This programme is now closed for expressions of interest.
A programme to fund targeted quality improvement work to increase continuity in general practices.
Inspired by 2018 Health Foundation research which demonstrated that patients with ambulatory care sensitive conditions who see the same GP a greater proportion of the time have fewer unplanned hospital admissions.
The programme explored the potential for general practice to increase continuity of care for its patients and improve their care.
Supported five projects for up to two and a half years between January 2019 and summer 2021.
About the programme
In 2019 the Health Foundation awarded five large-scale GP practices and federations grants of up to £250,000 over 18–24 months (with a six month pause in 2020 due to COVID-19) to carry out targeted quality improvement work to increase relational continuity of care.
The programme was inspired by Health Foundation research and, building on the already established evidence base on the benefits of continuity of care, sought to understand whether improvement approaches can be used to increase relational continuity of care in general practice. The programme was developed and delivered with the advice and support of the Royal College of General Practitioners (RCGP).
For this programme we commissioned a mixed methods evaluation from Mott Macdonald and also produced a quantitative descriptive analysis from the Improvement Analytics Unit (IAU).
Programme impact and learning
Despite changing and challenging conditions in primary care – including COVID-19 and rollout of the vaccination programme – project sites improved or maintained continuity based on several patient reported measures. The mixed-methods evaluation indicated that patients reported an increase in continuity of care during the programme (p39). The IAU analysis also confirmed that programme sites maintained or improved continuity while continuity of care decreased in England during the same period.
Balancing continuity of care and timely access can be challenging, but learning from the programme has shown the synergies that can be achieved when practices work with patients to ensure they get the kind of access that they need – including seeing their named or preferred GP. The mixed-methods evaluation found that only 15% of patients were not willing to wait longer to see their preferred GP (p45).
Implementing continuity of care interventions can lead to efficiency and quality gains, such as streamlined processes, better distribution of workload and more effective consultations. The mixed-methods evaluation also found that remote consultations were more efficient where the GP already had a relationship with the patient.
“The massive increase in remote consulting that has occurred caused by the COVID-19 pandemic has only emphasised further to me the importance of continuity of care for patient safety and practice efficiency.” – a mixed-methods evaluation stakeholder survey response.
Continuity can also enable patients to play a more active role in their own health and wellbeing. Patients who reported higher levels of continuity felt that they are more involved in decisions about their care and felt that the GP was more responsive to their needs and concerns.
“It’s a case of building a relationship with someone so that we’re both making decisions that are based on shared understanding.” – a mixed-methods evaluation patient survey response.
Episodic continuity is where patients are able to consult with the same GP for a particular episode of care or condition (compared to traditional longitudinal continuity where a patient sees the same GP for all health conditions and queries).
The mixed-methods evaluation found that episodic continuity can be a manageable first step if long-term continuity is not yet feasible (p66). This was a key component of the Valentine Health Partnership project. Their project showed that on average, around 60–65% of patients targeted for enhanced continuity in any three months reverted to lower levels of GP attendance
There is no accessible widespread tool for measuring continuity of care, and local project teams developed their own measurement approaches to track progress. However, measurement is a vital first step in increasing continuity, and was central to this programme.
For further information around key measurement tools and resources the Continuity of Care Toolkit outlines different approaches and methods used by project teams to measure continuity.
Further details on specific interventions can be found in the accompanying project reports and are summarised in the mixed-methods evaluation.
Tools and resources
Continuity of Care Toolkit
As part of the programme, Morecambe Bay Primary Care Collaborative and One Care CIC, collaborated to produce the Continuity of Care Toolkit – an in-depth, practical guide to improving continuity, drawing on quality improvement methods and approaches, and real world examples. The toolkit guides practices through their continuity improvement journey and is hosted by RCGP.
A guide to personal lists
Alongside the Toolkit, St Leonards Research Practice developed a guide to implementing and managing personal lists in general practice which draws on several different practices and includes detailed advice about the practicalities of developing and using personal lists.
Continuity of care webinars
Watch the programme webinars where programme sites outline the evidence base for continuity, key tips for implementation, the vital role of measurement, and what the project sites have learned about what it takes to increase continuity in practice.
This project aimed to help patients to develop a therapeutic relationship with their preferred clinician by introducing micro-teams and implementing systems that match clinical capacity to demand.
Introduced interventions including seminars in each practice for GPs, staff and patients, continuity measurement methods, patient surveys and promotional materials to help increase commitment to conti...