A method for measuring continuity of care in day-to-day general practice.

Problem

Continuity of care is widely acknowledged as being an important feature of general practice and has recently been linked to decreased hospital admissions and mortality. However continuity of care is currently in decline and is rarely measured in day-to-day general practice. It is difficult to improve something that is not regularly measured. However, current methods for measuring continuity, mainly used in research, require minimum numbers of appointments or long time scales, and/or may be difficult to calculate within a general practice. We aimed 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 general practice. We also compared it to other existing methods, in particular the widely-used Usual Provider of Care (UPC) index.

Approach

The SLICC has been developed in a service general practice and used for over 40 years. It is simple to calculate using practice computing systems such as SystmOne, together with Microsoft Excel. To demonstrate its use, we analysed appointment audit data from 2016-2017 in a general practice with 8823-9409 patients and 7 part-time partners and 1-2 GP Registrars. The practice uses a personal list system, although the SLICC could also be applied to the named GP, which is a national requirement. The SLICC (the percentage of face-to-face appointments with the patients’ personal GP) was calculated monthly for each doctor’s list. The SLICC for different groups of patients was compared. The UPC index over the two years was also calculated, allowing comparisons between indices.

Findings

In the two years studied, there were 35,622 GP face-to-face appointments; 1.96 per patient per year. Overall, 51.7% (95% CI: 51.2-52.2%) of GP appointments were with the patients’ personal doctor. There was a large variation between months and between doctors, from below 30% in months where a doctor was on leave, to over 70% for one list. Over 65s had a higher level of continuity with 64.9% of appointments being with their personal doctor. More deprived patients, males and patients with over seven appointments also had a higher SLICC. The mean whole-practice UPC score was 0.61 (SD= 0.23), with “usual provider” being the personal GP for 52.8% and a trainee or locum for 8.1% of patients. Again, patients aged over 65 had a significantly (P<0.001) higher UPC (mean 0.69, SD 0.22), than those below 65 (mean 0.58, SD 0.23).

Consequences

We demonstrate that a reasonable level of continuity can be achieved in a training general practice where all GPs are part-time. The 65% continuity for the over 65s is likely to cover most patients with multimorbidity. This method could provide working GPs with a simple way to track continuity of care and inform practice management and decision making.