News - Blog from the Guru of Continuity of Care Sir Denis Pereira GrayDate:
What is the future for continuity of care in 2019 GP-land ?
The benefits of continuity to a healthcare system. Denis Pereira Gray and Kate Sidaway-Lee share the evidence
In single -handed and small general practices, continuity is a constant feature and its advantages have long been well understood. However, in recent years general practices have got bigger, GP vacancies have risen and other health professionals have arrived, all meaning that continuity of care has diminished. Many of the DoH initiatives have prioritised other things. Some big group practices have given up even trying to provide continuity. A pendulum has swung hard in one direction.
Recently however, there have been some interesting developments. Patients have been vociferous that they want to see the GP of their choice and that they hate repeating their history to strange doctors. Secondly, a substantial amount of medical research both in the UK and around the world has been published which has shown how continuity of care is associated with a whole range of benefits for patients. These benefits include: more satisfied patients, patients who follow medical advice significantly more and take up offers of personal preventive medicine (like immunisations and cancer screening) much more. Patients with continuity of GP care attend accident and emergency departments significantly less and even have fewer admissions to hospital.
Then, in 2018, the first systematic review of continuity of doctor care and mortality reported that in 82% of published studies continuity was associated with a significant reduction in mortality. This article is open-access and so is available to all members of the Family Doctor Association. (https://bmjopen.bmj.com/content/8/6/e021161) It has attracted widespread interest around the world as death is the ultimate outcome. The published studies came from four continents with different cultures and health systems, so this is likely to be a human effect. This finding is not just applicable to GPs as continuity was linked to lower mortality for specialists too, including physicians, psychiatrists, and surgeons.
The Health Foundation, a leading London think tank, has now launched a national project exploring five different ways of increasing continuity of GP care (https://www.health.org.uk/funding-and-partnerships/programmes/increasing-continuity-of-care-in-general-practice). Will the continuity pendulum start to swing back?