Continuity of care in general practice is associated with better healthcare outcomes, higher patient satisfaction, increased adherence to medication, reduced hospital use and lower mortality. The Health Foundation has an improvement programme promoting continuity of care in 5 GP super practices (THFCOC programme). Super practices are groups of GP practices that have merged to form a partnership.
In the last few years, GP practices have started to adopt digital-first approaches to accessing and delivering primary care. This means that patients can access care via an online platform, after which they are triaged, and a consultation is conducted remotely before being offered a face-to-face consultation only if necessary. The introduction of these new care pathways was already accelerating due to the contract reform framework requiring all GP practices to offer online and video consultations by April 2021, but increased exponentially at the start of the COVID-19 pandemic, when all GP practice were encouraged to deliver all consultations remotely either by telephone, online or video.
The ability to access and deliver primary care remotely promises to provide faster access and decrease GP workload. However, the impact of digital-first primary care on continuity of care in general practice has not been explored. In this analysis we use patient-level data to describe trends in continuity of care and explore how continuity of care has been impacted by both the ability to access and deliver care remotely, and the COVID-19 pandemic, between March 2018 and March 2021 (or latest available date).
The aim of this project is to chart trends in continuity of care with a general practitioner over time between March 2018 and March 2021 and to assess how continuity of care was impacted by both new models of digital first primary care and the COVID-19 pandemic.
We will use data from electronic health records entered into CPRD for non-temporary patients registered at a nationally representative set of English general practices between 1 April 2016 and the latest available date. We will link CPRD data at the patient level to HES-APC data and IMD. We will also link CPRD data at the GP practice level to indicators of rurality (from the ONS) and participation in the COC programme.
Primary care contacts will be classified by consultation mode (remote or face-to-face) and staff type. Continuity of care will be measured using the usual provider of care (UPC) index, defined as the proportion of the patient’s contacts during the previous 12 months that that were with the most regularly seen doctor. We define the remote consultation index (RCI) as the proportion of a patient’s contacts during the previous 12 months that that were delivered remotely. We will calculate the UPC index and the RCI for each patient each month between March 2018 and the latest available date.
We will chart trends in average monthly UPC and RCI, stratified by age, sex, multimorbidity, socio-economic deprivation, higher and lower users of general practice care and practice participation in the THFCOC programme. We will use hierarchical logistic regression models to test the cross-sectional (between-person) association between UPC index and RCI in two cross-sectional studies using data from February 2020 and February 2021. We will then use fixed effects longitudinal regression models to identify whether within-person changes in RCI are associated with changes in UPC index.
Usual provider of care (UPC) index; Bice-Boxerman continuity of care index.
Geraldine Clarke - Chief Investigator - The Health Foundation
Elizabeth Crellin - Corresponding Applicant - The Health Foundation
Caroline Fraser - Collaborator - The Health Foundation
Emma Vestesson - Collaborator - The Health Foundation
Minal Bakhai - Collaborator - NHS England
Rebecca Fisher - Collaborator - The Health Foundation
Will Parry - Collaborator - The Health Foundation
HES Admitted Patient Care;Patient Level Index of Multiple Deprivation;Practice Level Rural-Urban Classification