Improving access to primary care is a priority for the new government and nobody will argue against that. But perhaps we should pause to consider what kind of access and to whom. There is a danger we could fill our capacity managing minor illness, much of which is self-limiting.
No doubt we would unearth more significant conditions as every haystack might contain a needle and primary care is highly skilled at finding these needles through the management of uncertainty and undifferentiated illness.
But looking at the facts around the burden of disease, it’s really access to continuity of care for patients with long term conditions which is most pressing and will have the most benefit. I would argue that this should be our focus when we think about access.
Minor illnesses account for a significant percentage of general practice consultations in England, with estimates ranging from 18% to 30%.
By contrast, 40% of adults in England live with a long-term condition and around 30% live with three or more conditions that impact on their quality of life and increases utilisation of NHS services. Currently around 65% of people are an unhealthy weight with around 25% being obese. This figure is estimated to rise to 50% by 2050. The rise in multimorbidity is a critical challenge for health and wellbeing and access to care services and there is a pressing need to accelerate our efforts to rise to this challenge.
In a world where there are significant workforce constraints in primary care including the shortage of GPs – although the latest announcement from the new health secretary, Wes Streeting, regarding funding to ensure placements for newly qualified GPs is very welcome – I believe we should re-focus our resource in meeting the needs of people with more complex needs and the current government policy needs to drive the right inputs and outcomes. We need a collective focus on continuity of care from policy to the consulting room. But what does continuity of care mean?
Continuity of care and Barbara Starfield
Continuity of care exists where there is a consistent and ongoing therapeutic relationship between patients and their healthcare professional(s) that is maintained over time.
Coordinating care across different services and providers to ensure a cohesive approach to a patient’s treatment is an important aspect of this continuity as is the importance of the availability of information about the person’s health.
This continuity is not only central to effective healthcare delivery but also significantly impacts patient outcomes by reducing morbidity and mortality rates as well as reducing utilisation of services.
Barbara Starfield was a distinguished professor and researcher at Johns Hopkins University, renowned for her extensive research in primary care. She focused on understanding how primary care improves health systems and outcomes. Her work emphasised the importance of access, continuity, and comprehensive care in achieving high-quality healthcare. What does her extensive research tell us?
The importance of continuity of care
- Improved Health Outcomes:
- Prevention: Starfield’s research highlighted that continuity of care is crucial for the effective delivery of preventive services. Regular interactions with the same healthcare provider increase the likelihood of receiving timely vaccinations, screenings, and health education.
- Long-term conditions: Continuous care allows for better monitoring and management of chronic conditions, leading to improved health outcomes and reduced complications.
- Enhanced Patient Satisfaction:
- Patients who have an ongoing relationship with their healthcare provider tend to have higher levels of trust and satisfaction. This relationship fosters better communication, adherence to treatment plans, and overall patient engagement in their health.
- Cost-Effectiveness:
- Continuity of care has been shown to reduce healthcare costs by minimising unnecessary tests, procedures, and hospital admissions. Starfield’s work demonstrated that primary care systems emphasising continuity are more efficient and cost-effective.
- Better Coordination of Care:
- Continuity facilitates better coordination among various health and care services. This is particularly important for patients with complex health needs who need care across different settings.
From Starfield to Streeting
How might we achieve access to quality continuing care going forward? It feels like trying to fit square pegs into round holes. But here are three ideas:
Increase access to self-help support by activating our patients and communities to use the assets and services around them, including the valuable support offered within the voluntary sector, to build their own health, wellbeing and ongoing resilience. We need to prioritise the development and deployment of digital tools such as the NHS App to enable and encourage uptake of this.
Increase access to a consistent and ongoing therapeutic relationship between patients and their healthcare professional. Activate our workforce to design support and care models in partnership with their communities that prioritise this. A number of our CARE participant case studies demonstrate examples of this:
Increase access to coordinated care through highly effective team working bringing together the full breadth of our primary and community professionals around our natural communities needs underpinned by shared knowledge through our information systems. Investing in our workforce to develop their team working capability and overcoming obstacles to working across organisational or contractual barriers through the development of Integrated Neighbourhood Teams.
Conclusion
Continuity of care is a cornerstone of effective general practice, contributing to better health outcomes, higher patient satisfaction, and more efficient use of healthcare resources. The evidence overwhelmingly supports the benefits of maintaining continuous, long-term relationships between patients and their healthcare professional. By prioritising continuity of care through various strategies, healthcare systems can ensure that patients receive comprehensive, cost-effective, coordinated, and compassionate care
