Continuity of care within general practice should become NHS policy, a study has suggested after finding people with dementia who consistently see the same GP tend to have lower rates of health complications.
Analysis of more than 9,000 patient records indicated that people diagnosed with dementia who were seen by the same GP over a one-year period were 10% less likely to have an emergency hospitalisation, compared to those who saw multiple GPs.
They were also 35% less likely to develop delirium – a state of severe confusion – and were less likely to be given medicines that can cause drowsiness and falls.
Led by the University of Exeter and published in the BJGP, the study noted that these symptoms and subsequent hospital admissions come at a high cost to the NHS.
Policymakers should encourage the provision of more GP continuity, which is currently recognised as an essential feature of general practice, the authors suggested.
‘Education on the value of continuity research is needed for undergraduates, postgraduates, and in continuing professional development,’ they wrote, adding that the DHSC should support these efforts.
Previous BJGP research has indicated that continuity in general practice has ‘declined substantially’ in the last decade, in line with reforms that prioritised access to GPs over continuity of GP care (CGPC).
They suggested that general practice requires similar policy to that found in the NHS Long Term Plan for midwifery, which had set out plans to offer all pregnant women the opportunity to have the same midwife throughout their pregnancy to improve clinical outcomes.
However, previous attempts to encourage CGPC – such as the ‘named GP’ scheme – were found not to have made significant improvements.
Drop in continuity of care
The authors suggested that a lack of funding and initiatives focusing on ease of access are both associated with the drop in continuity in general practices in recent years.
Patients with dementia are ‘particularly vulnerable’ to the pressures currently facing primary care, they said, including high workloads, limited funding and staffing crises – and these patients often receive a lower CGPC as a result.
However, Dr Richard Oakley, associate director of research at Alzheimer’s Society, noted that the pandemic has put GP services ‘under immense pressure’.
He conceded that ‘while we might not be able to get consistent GP care for everyone with dementia’ immediately, policymakers should ‘absolutely be working with the NHS to build this into their plans as we emerge from the pandemic’.
Similarly, Sir Denis Pereira Gray, co-author and GP researcher at the St Leonard’s Practice, Exeter, said that although ‘national policy makers have for years discouraged continuity, general practices can still provide good GP continuity through their internal practice organisation’.
Last year, a study found that long-term continuity of GP care is ‘strongly associated’ with lower mortality and reduced need for acute hospitalisations and out-of-hours services.
Meanwhile, analysis of UK GP Patient Survey responses found that GP practice expansions have led to poorer continuity of care.