National Health Service Employers and General Medical Services agreed that patients aged 75+ should have a named accountable GP to provide personalised care to keep them healthy and out of hospital. General practices were required to follow this policy from mid-2014 onwards. The ultimate aim is to find out whether this policy has been effective. We examine whether the introduction of the assignment of a named GP led to better continuity of care. If continuity of care improved, we assess whether this led to fewer emergency hospital admissions. We will obtain data from a random sample of 30,000 patients aged 65-85 in 2012, from the Clinical Practice Research Datalink (CPRD). The CPRD is linked with data showing which patients were admitted to hospital. These data contain information on every contact each patient had with their general practice and any hospital admissions between April 2012 and April 2016. This includes a two-year period before and after the introduction of the named GP scheme. This allows us to compare a patient's continuity of primary care and a patient's experience of emergency hospital admission before and after the scheme was introduced while taking into account factors such as age, co-morbidities and practice services.
National Health Service Employers and General Medical Services agreed to introduce from mid-2014 a named accountable GP for all patients aged 75+. This study aims to investigate whether this intervention 1) improved patients' continuity of care and 2) decreased their risk of emergency hospital admission. This cohort study obtains a random sample of 30,000 patients aged between 65-85 in 2012 from the Clinical Practice Research Datalink (CPRD), who were registered with their practice at least one year prior to 2012 and who were alive in 2014. The CPRD is linked with Hospital Episode Statistics showing emergency hospital attendance and admissions. Patients will be followed between April 2012-April 2016, comprising a two-year period before and after the intervention. As a patient's continuity of care and emergency hospital admission will be measured in the pre-intervention and post-intervention period, this study uses a multilevel model to analyse repeated measurements over time (within patients) whereby time-period is level-1, patients is level-2, and general practices is the level-3 unit. A mediation analysis, adjusted for confounders at the individual and practice level, will test the hypothesised causal chain in which a named GP improves continuity of care that, in turn, decrease risk of emergency hospital admission.
Continuity of primary care; GP referrals and admission through A&E.
Peter Tammes - Chief Investigator - University of Bristol
Peter Tammes - Corresponding Applicant - University of Bristol
Chris Salisbury - Collaborator - University of Bristol
Fiona MacKichan - Collaborator - University of Bristol
Richard Morris - Collaborator - University of Bristol
Rupert Payne - Collaborator - University of Bristol
Sarah Purdy - Collaborator - University of Bristol
HES Admitted Patient Care;HES Admitted Patient Care;ONS Death Registration Data;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Patient Level Index of Multiple Deprivation;Other;Other