Measuring continuity of care in general practice: a comparison of two methods using routinely collected data

Abstract

Background: Despite well-documented clinical benefits of longitudinal doctor-patient continuity in primary care, continuity rates have declined. Assessment by practices or health commissioners is rarely undertaken.

Aim: Using the Usual Provider of Care (UPC) score this study set out to measure continuity across 126 practices in the mobile, multi-ethnic population of East London, comparing these scores with the General Practice Patient Survey (GPPS) responses to questions on GP continuity.

Design and setting: A retrospective, cross-sectional study in all 126 practices in three East London boroughs.

Method: The study population included patients who consulted three or more times between January 2017 and December 2018. Anonymised demographic and consultation data from the electronic health record were linked to results from Question 10 ('seeing the doctor you prefer') of the 2019 GPPS.

Results: The mean UPC score for all 126 practices was 0.52 (range 0.32 to 0.93). There was a strong correlation between practice UPC scores measured in the 2 years to December 2018 and responses to the 2019 GPPS Question 10, Pearson's r correlation coefficient, 0.62. Smaller practices had higher scores. Multilevel analysis showed higher continuity for patients ≥65 years compared with children and younger adults (β coefficient 0.082, 95% confidence interval = 0.080 to 0.084) and for females compared with males.

Conclusion: It is possible to measure continuity across all practices in a local health economy. Regular review of practice continuity rates can be used to support efforts to increase continuity within practice teams. In turn this is likely to have a positive effect on clinical outcomes and on satisfaction for both patients and doctors.

Keywords: continuity of patient care; health surveys; primary health care; routinely collected health data.

Figure 1.

Continuity scores (UPC) plotted against list size, for 126 GP practices in three neighbouring boroughs in East London between January 2017 and December 2018. (Each diamond represents a practice in one of the three London boroughs. The dotted line is the logarithmic trend line for all 126 practices. UPC = Usual Provider of Care.)