Is continuity of primary care declining in England? Practice-level longitudinal study from 2012 to 2017

Abstract

Background: Continuity of care is a core principle of primary care related to improved patient outcomes and reduced healthcare costs. Evidence suggests continuity of care in England is declining.

Aim: To confirm reports of declining continuity of care, explore differences in decline according to practice characteristics, and examine associations between practice populations or appointment provision and changes in continuity of care.

Design and setting: Longitudinal design on GP Patient Survey data reported annually in June or July from 2012 to 2017, whereby the unit of analysis was English general practices that existed in 2012.

Method: Linear univariable and bivariable multilevel models were used to determine decline in average annual percentage of patients having a preferred GP and seeing this GP 'usually' according to practicelevel continuity of care, rural/urban location, and deprivation. Associations between percentage of patients having a preferred GP or seeing this GP usually and patients' experiences with the appointment system and practice population characteristics were modelled.

Results: In 2012, 56.7% of patients had a preferred GP, which had declined by 9.4 percentage points (pp) (95% CI = -9.6 to -9.2) by 2017. Of patients with a preferred GP, 66.4% saw that GP 'usually' in 2012; this had declined by 9.7 pp (95% CI = -10.0 to -9.4) by 2017. This decline was visible in all types of practices, irrespective of baseline continuity, rural/urban location, or level of deprivation. At practice level, an increase over time in the percentage of patients reporting good overall experience of making appointments was associated with an increase in both the percentage of patients having a preferred GP and those able to see that GP 'usually'.

Conclusion: Patients reported a steady decline in continuity of care over time, which should concern clinicians and policymakers. Ability of practices to offer patients a satisfactory appointment system could partly counteract this decline.

Keywords: GP Patient Survey; continuity of care; longitudinal studies; multilevel model; preferred GP; primary care.

Figure 1.

Percentage of patients in English general practices having a preferred GP and seeing their preferred GP ‘always’, ‘almost always’, or ‘most of the time’, 2012–2017. Data calculated from GP Patient Survey responses. Dotted lines = 95% confidence intervals.

Figure 2.

Change in mean percentage of patients having a preferred GP over the years 2012–2017 (95% confidence interval [CI]), according to average percentage at the level of the practice during the period, divided by quartiles. Data calculated from GP Patient Survey responses. Dotted lines = 95% CIs.

Figure 3.

Change in mean percentage (95% confidence interval [CI]) of patients in English general practices having a preferred GP by urban/rural location, 2012–2017. Data calculated from GP Patient Survey responses. Dotted lines = 95% CIs.

Figure 4.

Change in mean percentage (95% confidence interval [CI]) of patients in English general practices having a preferred GP by level of deprivation (quintiles), 2012–2017. Data calculated from GP Patient Survey responses. Dotted lines = 95% CIs.