Where is "My" GP?
The Importance of Continuity of Care in General Practice
As a cornerstone of general practice, continuity of care has long been recognized as a key driver of efficiency within the healthcare system. However, with the changing landscape of GP work patterns, including more part-time roles and portfolio careers, as well as the varied clinical workforce now present in practices, maintaining continuity of care has become increasingly challenging.
This issue is set to become a political priority, with the opposition Labour party stating their intention to incentivize continuity of care in primary care if elected. Given the potential efficiency gains and improved patient outcomes associated with continuity, it is worth examining ways to enhance it within our practices.
Benefits of Continuity of Care
- Stronger doctor-patient relationship and increased trust, allowing for appropriate reassurance and "safe shortcuts"
- Reduced over-investigation due to better understanding of the patient's history
- Higher patient satisfaction and fewer complaints
- Improved health outcomes for patients seen regularly by the same clinician
Strategies to Improve Continuity
1. Strict Patient Lists: The traditional model where patients are assigned to a specific GP. Challenges include part-time working patterns leading to increased wait times, and potential burnout for GPs who collect a disproportionately large collection of “heart sink” patients.
2. Booking Follow-ups: GPs book patients' future appointments during the current visit. This can be difficult to predict when follow-up will be needed and can lead to unnecessary extra appointments being booked.
3. Cohorting High-Need Patients: Patients likely to require more continuity (e.g. multi-morbidity, frailty, cancer) are assigned to specific clinicians or clinical teams for their care.
4. Clinical Buddy System: GPs are paired or grouped, increasing the likelihood of patients seeing the same clinician within that group.
5. Total Clinical Triage: All requests for appointments are reviewed by a clinician who assesses the need for continuity and assigns the patient to the appropriate clinician they have recently seen. Allows for safe timeframes and alternate appointments when necessary.
The total clinical triage model, in particular, offers a comprehensive approach to improving continuity while maintaining efficiency and accessibility. By having clinicians review appointment requests, patients can be directed to the most appropriate provider, whether that is their regular clinician for continuity of care, or another team member for more acute needs.
Continuity remains a vital component of general practice, and one that we must strive to uphold amid the changing landscape. Exploring and implementing strategies like those outlined above can help us deliver more efficient, patient-centred care while fostering those all-important long-term therapeutic relationships.
What are your thoughts? How do you manage this problem? Let me know
We have personal lists and are all part time but manage it by spreading our days across the week- strive to all work Mondays and Fridays On days we are not in other see our urgents but most things can wait a day until the patients GP is in and appts are embargoed for this. Personal lists control demand as the GP can feed back what was an appropriate appt and what was not and because they have a relationship with the patient the patient sometimes listens. It is a myth that continuity reduces access. We have very good access- it is poor capacity that reduces access- not enough GP appts. The whole system lacks funding for current demand. It is not the fault of the old fashioned system- be careful what you get rid of-