Researchers have confirmed the benefits of seeing the same GP over time, finding that these include improving patient health, extending intervals between visits, and resulting in a reduction in the doctor’s workload.
Led by a team from the University of Cambridge and Insead Business School, the study found that having a long-term relationship with a doctor, and seeing the same doctor during GP visits – a model known as continuity of care – meant people waited on average 18% longer between visits, compared with patients who saw different doctors each time.
Less GP time was taken in each consultation, they said, and the findings were particularly strong for older patients, those with multiple chronic illnesses, and people with mental health conditions.
Although it will not always be possible for people to see their regular GP, the findings would translate to an estimated 5% reduction in consultations if all practices in England provided the level of continuity of care of the best 10% of practices, they added.
“Importantly, if patients receiving care from their regular doctors have longer intervals between consultations without requiring longer consultations, then continuity of care can potentially allow physicians to expand their patient list without increasing their time commitment.”
The Independent reports that for the study, published in the journal Management Science, experts analysed more than 10m GP consultations in 381 practices in England over 11 years.
The study noted that: “A physician can be considered more productive if they improve the quality of care provided without reducing the number of patients served per year or if they serve more patients without reducing quality of care.
“In primary care, where patients often have a preferred doctor, these two dimensions are related.
“If physicians provide high-quality care to their regular patients, they are likely to keep them healthier, reducing the demand for consultations and increasing their capacity to serve more patients.”
Co-author professor Stefan Scholtes, from Cambridge Judge Business School, said seeing the same doctor could have substantial benefits, equivalent to increasing the GP workforce by 5%.
He said that “getting it right the first time” will reduce future workloads by “preventing revisits”: “Better health translates into less demand for future consultations. Prioritising continuity of care is crucial in enhancing productivity.”
For the study, researchers used anonymised data from the Clinical Practice Research Datalink, consisting of more than 10m GP visits between 1 January 2007 and 31 December 2017.
The study restricted itself to patients who’d had at least three consultations over the past two years.
Dr Harshita Kajaria-Montag – now based at the Kelley School of Business at Indiana University in the US – said: “The benefits of continuity of care are obvious from a relationship point of view.
“If you’re a patient with complex health needs, you don’t want to have to explain your whole health history at every appointment.
“If you have a regular doctor who’s familiar with your history, it’s a far more efficient use of time, for doctor and patient.”
Analysis of England’s GP patient survey data by the Nuffield Trust shows that when asked “How often do you see or speak to your preferred GP when you would like to?” there has been a decline in continuity of care over time.
Between 2018 and 2023, the proportion of patients who “always or almost always” saw or spoke to their preferred GP decreased from 26% to 16%, while those who answered “never or almost never” increased from 10% to 19%.
Study details
Continuity of Care Increases Physician Productivity in Primary Care
Harshita Kajaria-Montag, Michael Freeman, Stefan Scholtes.
Published in Management Science on 24 January 2024
Abstract
Continuity of care, defined as an ongoing therapeutic relationship between a patient and a physician, is a defining characteristic of primary care. However, arranging a consultation with one’s regular doctor is increasingly difficult as practices face physician shortages. We study the effect of declining care continuity on the productivity of physicians by analysing data of more than 10m consultations in 381 English primary care practices over a period of 11 years. Specifically, we examine whether a consultation with the patient’s regular doctor is more productive than with another doctor in the practice. Using statistical models that account for confounding and selection bias and restricting the sample to consultations with patients who had at least three consultations over the past two years, we find that the time to a patient’s next visit is on average 18.1% (95% confidence interval: 16.9%, 19.2%) longer when the patient sees the doctor they have seen most frequently over the past two years, while there is no operationally meaningful difference in consultation duration. The data show that the productivity benefit of care continuity is larger for older patients, patients with multiple chronic conditions, and patients with mental health conditions. We estimate that the total consultation demand in our sample could have fallen by up to 5.2% had all practices offered continuity of care at the level of the top decile of practices while prioritising patients expected to yield the largest productivity benefits. We discuss operational and strategic implications of these findings for primary care practices and for third-party payers.
The Independent article – Landmark study shows health benefits of seeing the same GP (Open access)
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