Continuity of care should be ‘essential requirement’ for GPs

Making continuity of care an ‘essential requirement’ for GP practices could reduce the risk of a delay in diagnosing serious health conditions, a new report has said.

The report from the Health Services Safety Investigations Body (HSSIB), an independent safety investigations body, identified that there is no specific requirement within the current GP contract to ensure GP practices provide continuity of care for their patients, resulting in variation across England.

Continuity of care in the report referred to personal (a relationship with a specific doctor) but also informational, meaning how information is managed in the practice to allow any doctor to care for the patient.

The HSSIB said although GPs know the benefits of continuity of care, some did not believe it was possible to deliver that system of care in their practice. They cited many challenges from the complex social conditions of their geographical area to staff stability and availability.

In relation to essential requirements coming from the GP contract, practices told them that this creates competing priorities and that if there is no explicit requirement to adopt a system of continuity of care, it will ‘slip down’ the priority list when there are other challenges coming to the fore.

The authors recommend that the Department of Health and Social Care ensure that the GP contract explicitly includes and supports the need for GP practices to deliver continuity of care. This is to improve patient safety by building clinician–patient relationships as well as providing continuity of information.

They also recommend that NHS England updates the GP IT standards to ensure patient continuity of care is maintained, including the identification and prioritisation (technically known as ‘clear surfacing’) of information to health and care professionals, when patients visit GP practices multiple times with unresolving symptoms.

Need to prioritise continuity of care in a consistent way

Neil Alexander, Senior Safety Investigator, said: “What struck our team during the investigation was the clear differences in patient experience and GP welfare between those practices that operate a model continuity of care and those that don’t.

“We could see that all want to deliver the best care they can but the extreme pressure of workloads and having to prioritise other essential requirements makes it very difficult. Even though practices with systems could see benefits, they told us they had often implemented without proper frameworks, guidance, and explicit funding. It became clear to us that in order for GP practices to be able to prioritise continuity of care in a consistent way, it must become part of the essential services they need to deliver.”

The report also found that there was a visible difference in the demeanour between staff in practices that operate continuity of care and those that did not. The investigation observed first-hand the personal impact, as many became visibly upset when speaking about their workload and work environment.

Some of the examples shared by GP’s included:

• not having time to process technically difficult consultations resulting in cognitive fatigue, making decision making harder as the day progressed
• feeling unable to do all the tasks required during a consultation
• taking work home and into days off and weekends.

Huge amount of pressure on GPs to prioritise quick access to care and services

The Royal College of GPs, in response to the report, said that continuity of care is highly valued by GPs and patients alike – particularly those patients with complex health needs. This is because it allows GPs to build trusting relationships with their patients, and this study highlights it has benefits for patients and the wider NHS.

But it added that delivering continuity of care is becoming increasingly difficult as GPs and their teams struggle with intense workforce pressures and patient need growing in both volume and complexity.

Dr Victoria Tzortziou-Brown, Vice Chair of the Royal College of GPs, said: “GP teams across the country do strive to deliver continuity of care in innovative ways, in line with daily pressures and new ways of working; for example, by prioritising patients who would most benefit from continuity and fostering trusting relationships between patients and several members of our multi-disciplinary teams, including GPs. The challenge is that there is a huge amount of pressure on GPs to prioritise quick access to our care and services over other important factors for patient care, such as continuity.

“Making continuity of care a ‘requirement’ is not straightforward, as it may mean different things to different practices and patients, and some patients may value it and benefit from it more than others. As with any targets, there are also risks associated with taking an inflexible approach that could lead to unintended consequences. Ultimately, given current pressures, it’s hard to see how such a requirement would be feasible for many practices. What we do need to see is more resources for general practice and thousands more GPs and other members of the team, so that practices can ensure their patient populations can get the appropriate care they need.”