Prof. Dr. Harshita
Kajaria-Montag

Background Workload is probably the biggest challenge facing general practice and little is known about any modifiable factors. For GPs, both continuity and locum status are associated with differences in outcomes. Aim To determine whether practice and hospital workload after an index acute consultation depend on the type of GP consulted (locums and practice GPs with [regular] and without [non-regular] continuity, and locums). Design and setting An observational, cross-sectional analysis of consultation-level data from English general practices from the Clinical Practice Research Datalink from 2015 to 2017. Method Antibiotic prescription was used as a marker for acute consultations with regression models to calculate adjusted relative risks for emergency department consultations and admissions, outpatient referrals, and test ordering, as well as the patients’ GP reconsultation interval following consultations with the three types of GP. Results After adjustment, consultations with antibiotic prescriptions with regular GPs with continuity were associated with fewer subsequent hospital admissions and lower emergency department use but higher outpatient referrals relative to locums and non-regular GPs. Locums ordered tests less often (relative risk [RR] –24.3%, 95% confidence interval [CI] = –27.3 to –21.2) than regular GPs whereas non-regular GPs ordered tests more often (RR 19.1%, 95% CI = = 16.4 to 21.8). Patients seeing their regular GP had on average a 9% longer (95% CI = 8 to 10) reconsultation interval than if they saw any other GP. Conclusion The differences in outcomes were associated more with having continuity than with GP locum status. Seeing a GP with whom the patient had continuity of care was associated with reduced workload within the practice and in hospital.

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 analyzing data of over 10 million 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 prioritizing 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.