Pandemic lockdown exacerbated ongoing declines in continuity of care within English general practices

Background and Goal: Longitudinal continuity of care is the repeated contact between an individual and the same general practitioner (GP). This type of continuity of care is widely regarded as a cornerstone of primary care. Higher levels of longitudinal continuity of care are associated with better health outcomes, greater patient satisfaction, and more cost-effective use of health care resources. This study aimed to describe more recent variations between practices in the slopes of longitudinal continuity of care levels across the COVID-19 pandemic. The study also set out to determine if practice-related factors predicted these variations.

Study Approach: Researchers used the General Practice Patient Survey for the period of 2018- 2022 to analyze data from English general practices with longitudinal continuity of care information. The study included only active practices with at least 750 registered patients. The outcome was the percentage of each practice’s patients who had both a preferred GP and the ability to see that GP repeatedly. The study examined eleven population and practice related factors as potential independent predictors of longitudinal continuity of care variation. Factors included baseline longitudinal continuity of care (in 2018), English National Health Service (NHS) region (London, South East, South West, East of England, Midlands, North East and Yorkshire, or North West), deprivation score, rurality (urban or rural), percentage of White patients and numbers of general practitioners and nurses per 10,000 patients.

Main Results:

• Overall Decline in Continuity: In 2018-2022, the mean of longitudinal continuity of care levels across 6,010 practices decreased markedly from 29.3% to 19.0% of patients.

• Steeper Decline Post-COVID-19 Lockdown: This decline steepened in 2021- 2022, following the COVID-19 lockdown.
• Increasing Variations in Continuity: The coefficient of variation (a measure of relative variability) increased from 48.1% to 63.6% in 2018-2022, indicating progressively widening differences between practices.
• Predictors of Variations in Decline of Continuity:
  • More general practitioners and higher percentages of patients seen on the same day as booking predicted slower declines.
  • Higher baseline longitudinal continuity of care, living in four of the six regions outside London, and higher percentages of White ethnicity predicted faster declines.

Why It Matters: The findings suggest that factors linked to greater appointment availability predicted slower declines in longitudinal continuity of care levels in English general practices. To prevent the further loss of continuity, the researchers urge immediate nationwide action to improve appointment availability. 

Ongoing Decline in Continuity with GPs in English General Practices: A Longitudinal Study Across the COVID-19 Pandemic

Louis Steven Levene, FRCGP, PhD, et al

Department of Population Health Sciences, University of Leicester, Leicester,

England

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