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. 2019 May;69(682):e356-e362.
doi: 10.3399/bjgp19X701813. Epub 2019 Feb 25.

A method for measuring continuity of care in day-to-day general practice: a quantitative analysis of appointment data

Kate Sidaway-Lee  1 , Denis Pereira Gray  1 , Philip Evans  1
Affiliations

A method for measuring continuity of care in day-to-day general practice: a quantitative analysis of appointment data

Kate Sidaway-Lee et al. Br J Gen Pract. 2019 May.

Abstract

Background: Despite patient preference and many known benefits, continuity of care is in decline in general practice. The most common method of measuring continuity is the Usual Provider of Care (UPC) index. This requires a number of appointments per patient and a relatively long timeframe for accuracy, reducing its applicability for day-to-day performance management.

Aim: To describe the St Leonard's Index of Continuity of Care (SLICC) for measuring GP continuity regularly, and demonstrate how it has been used in service in general practice.

Design and setting: Analysis of appointment audit data from 2016-2017 in a general practice with 8823-9409 patients and seven part-time partners, in Exeter, UK.

Method: The percentage of face-to-face appointments for patients on each doctor's list, with the patient's personal doctor (the SLICC), was calculated monthly. The SLICC for different demographic groupings of patients (for example, sex and frequency of attendance) was compared. The UPC index over the 2 years was also calculated, allowing comparisons between indices.

Results: In the 2-year study period, there were 35 622 GP face-to-face appointments; 1.96 per patient per year. Overall, 51.7% (95% confidence interval = 51.2 to 52.2) of GP appointments were with the patients' personal doctor. Patients aged ≥65 years had a higher level of continuity with 64.9% of appointments being with their personal doctor. The mean whole-practice UPC score was 0.61 (standard deviation 0.23), with 'usual provider' being the personal GP for 52.8% and a trainee or locum for 8.1% of patients.

Conclusion: This method could provide working GPs with a simple way to track continuity of care and inform practice management and decision making.

Keywords: continuity of patient care; family practice; general practice; measurement.

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Figures

Figure 1.
Figure 1.
Age and sex distribution of patients registered at St Leonard’s Practice during December 2016.
Figure 2.
Figure 2.
Patient consultations with own GP. The St Leonard’s Index of Continuity of Care (SLICC), which is the percentage of appointments provided for patients on a GP partner’s list that were with that GP, each month. The practice average is the percentage of all appointments in that month that were with the patient’s own GP.
Figure 3.
Figure 3.
The SLICC (percentage of appointments that are with the personal GP) by age group. Error bars represent 95% CIs. SLICC = St Leonard’s Index of Continuity of Care.
Figure 4.
Figure 4.
GP appointments with own-list patients. The own-patient ratio is the percentage of appointments with a specific GP partner that were with patients on their own personal list. The practice average uses the number of appointments that were with GPs who have lists as the denominator.
See this image and copyright information in PMC

Comment in

  • Reduction in face-to-face GP consultations.
    Gray DP, Sidaway-Lee K, Harding A, Evans P. Gray DP, et al. Br J Gen Pract. 2020 Jun 25;70(696):328. doi: 10.3399/bjgp20X710849. Print 2020 Jul. Br J Gen Pract. 2020. PMID: 32586804 Free PMC article. No abstract available.
  • Beyond relational continuity.
    Gray DP, Sidaway-Lee K, Harding A, Evans PH. Gray DP, et al. Br J Gen Pract. 2021 Sep 30;71(711):444. doi: 10.3399/bjgp21X717113. Print 2021 Oct. Br J Gen Pract. 2021. PMID: 34593405 Free PMC article. No abstract available.
  • Realistic not romantic - real-world continuity in action.
    Sayers LD, Richardson S, Colvin D, Pearson J, Davidson E, Berry H, Harman H, Marr D, Harrison S. Sayers LD, et al. Br J Gen Pract. 2023 Dec 28;74(738):11-12. doi: 10.3399/bjgp24X735909. Print 2024 Jan. Br J Gen Pract. 2023. PMID: 38154953 Free PMC article. No abstract available.

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