Primary Care
The announcement that continuity of care will be incentivised in general practice with a particular focus on chronic conditions has been greeted positively by many.
It crucially recognises the ‘happy alignment’ between patients and GPs on one of the fundamental tenets of general practice; the value of ‘the family doctor’ as a bedrock of consistent, high-quality care experiences. Those experiences can be mutually beneficial and rewarding for not only patients, but also clinicians.
And while commentators note that realising this vision will require additional capacity and investment in the years to come, the goal itself is right.
Indeed, a survey by the BMA reported that 80% of GPs regarded continuity of care as one of the essential components of general practice they valued the most. Furthermore, there is evidence that it can have a significant impact on patient outcomes and mortality, particularly with regard to complex patients.
Here, we explore some of the benefits of continuity of care in long-term condition management.
Living with a chronic condition is a deeply personal experience, relative to a person’s specific situation, thoughts and feelings. As a result, patients will more often than not have a preference to see the same clinician with whom they have formed an existing relationship.
Seeing the same physician can give comfort that the individual is speaking with someone who fully understands and grasps their situation, knows their medical journey and particular set of personal circumstances. It can also build familiarity and trust. This has been defined as relational continuity by the RCGP:
“Relationship continuity is longitudinal, personal, continuing and caring: it implies knowledge of each other within the context of the therapeutic relationship, with commitment and trust. Both doctor and patient contribute to its creation and maintenance. It can involve more than one clinician and it should be flexible over time, responding to the patient’s changing needs and social context”
- Promoting Continuity of Care in General Practice, RCGP Policy Paper
Relational continuity has been closely linked to patients feeling more able to ‘cope’ with their condition. For example, helping patients living with diabetes to gain a better understanding of its management and the day-to-day activities that go with optimal blood sugar control.
While for elderly patients living with chronic multimorbidity, it can have other practical benefits too. Whether it’s removing the need to repeat medical histories or enabling the physician to closely monitor any changes or new symptoms that arise and facilitate earlier intervention.
Just as patient populations have grown increasingly complex, so has the system itself. As patients with long-term conditions require a high number of repeat appointments across different specialities and care settings, one way to simplify that journey is providing a consistent touchpoint throughout.
That touchpoint resides in general practice. It can act as a ‘north star’ and help individuals orient and and find their way through an often fragmented system. When done right, this can produce gains elsewhere too. Indeed, there is evidence that continuity in general practice reduces secondary care costs, hospital admissions and urgent care visits. While patient satisfaction also goes up.
This has been defined as ‘management continuity’ and requires close coordination and collaboration across care settings. Alongside this, timely, accurate sharing of health information and clinical records has also been identified as essential for informational continuity within care handovers. The Health Foundation defines best practice as:
“Handovers of care between teams and organisations are timely and efficient, and patients’ preferences and needs are respected and met at every stage of their journey. For example, a patient’s care is well managed and coordinated across multidisciplinary teams within general practice or between primary and secondary care.”
Additionally, recent research also indicates productivity and efficiency gains for general practice where continuity is followed. In a study of 381 GP practices over an 11-year period, when patients saw their regular GP, time to next consultation extended by approximately 18%. Findings also indicate a potential reduction in overall consultation demand up to 5%. Gains were said to be particularly pronounced for patients with more complex needs such as older patients, those with chronic diseases, or those with mental health conditions.
Living with chronic illness can entail taking multiple medications as part of its management. Polypharmacy increases pill burden on patients and brings with it adherence challenges.
With a number of medicines to manage, sticking to a particular course of treatment can be hard for the individual. And where care experiences are inconsistent, it exacerbates medicines management problems and results in poorer outcomes.
However, evidence shows that patients who experience continuity of care are more likely to follow their medicine regimens in the long term.
An integrated, holistic approach to condition and medication reviews can be of particular value here. Facilitated by a specialist clinical pharmacist working alongside a patient’s GP, medications for all conditions can be reviewed and condition information collected and recorded in fewer contacts, removing the need for multiple appointments and reducing fragmentation.
Pharmacists can also play a vital role in the coordination process too.
“Pharmacists could work with GPs to resolve medication issues by conducting medicine reviews, and could liaise with hospitals, community pharmacists and care homes to ensure continuous care for patients. This would improve continuity, and be particularly beneficial for the numerous patients taking different medications.
- Continuity of Care in Modern General Practice, RCGP
Indeed, the growth of multidisciplinary teams does not have to result in loss of continuity when strong links are forged with the patient’s practice and across the system.
Furthermore, care continuity, when applied to the role of pharmacy itself, has also been shown to have benefits. In a study, individuals who saw the same pharmacist were more likely to adhere to treatment regimen, and less likely to engage in inappropriate medicines use.
Here at Suvera, we prioritise care continuity within our virtual clinics. Working in tandem with patients’ GP practices, all patients see the same clinical pharmacist for their planned condition and medication reviews.
Combined with a strong focus on management and informational continuity as patients move across settings, we consistently achieve optimal outcomes for our partners and high patient satisfaction. We have a track record in managing patients to target for hypertension, diabetes, asthma and cholesterol and 9 in 10 patients say they would recommend us.
To find out how we can support your practice, PCN or ICB, contact our team on partnerships@suvera.co.uk.