Can better continuity improve access to GP appointments? Findings from two Deep End practices in Bristol.

Problem

Good continuity (seeing a clinician you know) is associated with reduced mortality and unplanned hospital admissions, and increased patient and clinician satisfaction. In England, despite providing more appointments, continuity has decreased in recent decades with only 16% of patients reporting seeing their preferred GP ‘always or almost always’ (GP Patient Survey, 2023). Practices serving more deprived populations generally provide less continuity.

‘GPs at the Deep End’ is a network of 17 practices serving the most deprived populations in Bristol. In 2020, during the merger of two Deep End practices (Practice A), the lead author (a grassroots GP partner) enrolled on the Health Foundation’s ‘Increasing Continuity of Care in General Practice Programme’. A second Deep End practice (Practice B) embarked on their own project, modelling their strategy on the same programme. We aimed to evaluate what impact this had on continuity and number/proportion of appointments for frequent attenders.

Approach

The two practices, serving ̴33,000 patients used different approaches to improve continuity. Practice A implemented personal lists for all patients and Practice B for frequent attenders (≥9 appointments/year) only. In both practices, GPs were grouped into ‘microteams’ with a small number of clinicians covering each other. Care navigation, training, digital prompts and continuity champions (GPs leading the initiative) helped enable patients to see their named GP, and progress was tracked using routinely collected summary data via a dashboard. Continuity was measured using the Usual Provider of Care index (UPC; proportion of appointments a patient has with their most-seen GP over 12 months).

Findings

Between 2019/2020 and 2022/2023, UPC for Practice A increased from 0.31 to 0.48; average number of appointments/frequent attender fell from 13.8/year to 10.3/year; proportion of appointments used by frequent attenders fell from 40% to 21%; and the top 5% attenders used 2500 fewer appointments/year. For Practice B, between 2021/2022 and 2022/2023, the proportion of appointments used by frequent attenders fell from 40% to 15% (analysis ongoing).

Over the same period, the lead author noted improved recruitment of GPs, who actively valued and sought out continuity, and a reduction in workforce turnover. Knowing his (often complex) patients has created a greater sense of responsibility and enabled him to focus more on preventative healthcare.

Consequences

Preliminary findings from these two Deep End practices suggest that improving continuity may reduce the number of appointments for frequent attenders, improving access for all patients, and may improve clinician recruitment and retention. These benefits were realised within a short time, signifying fast and tangible impacts are possible. This is a small-scale project, however, and other factors may have influenced the fall in appointments (e.g. in practice B, GP triage of appointments was also introduced). Research is planned to further examine these data and to work-up a larger project.