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Having a named GP doesn’t improve older patients’ continuity of care, finds study

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5682 (Published 24 September 2019) Cite this as: BMJ 2019;366:l5682

Rapid Response:

Named GPs in general practice

We note the comment by Mahase (2019) [1] relating to Tammes et al 2019 [2], that having named doctors in general practice is not effective. This does not surprise us as without further interventions it remains an administrative process only.

It is true that if a general practice simply allocates the name of a GP to patients, as they are required to do by contract, and it does nothing to foster or improve continuity then there will be no effect on continuity of care. This has been shown before by Barker et al (2016) [3] from the Health Foundation. Using the same dataset, this group showed that patients who received higher continuity of GP care had a 12.5% reduction in hospital admissions. [4]

The most effective ways of improving continuity of care in general practice involve encouraging patients to see their usual/personal GP.

As this kind of system requires a named GP to be identified, it needs to be made clear that having a named GP is important but not sufficient for continuity of care in general practice. It is difficult to measure continuity of GP care without being clear who the GP is. We suggest that having a named GP acts as a gateway to an array of continuity-related measurement and management options. This could include personalised measurement of continuity and consultation rates as well as clarifying clinical responsibility for results, letters and other patient data. Sidaway- Lee et al (2019) [5] have described how personal lists can work and be measured.

The Bristol group (Tammes 2019) [2] stated that “more sophisticated interventions” are needed. However, straightforward policies are available in their own region. Several practices in the Bristol area are already using or implementing a usual doctor/ personal list system to improve continuity.

Although simply allocating a named GP is not effective in improving continuity, it remains an important first step. The next step is for practices to foster continuity within the practice and work to encourage patients to see their named doctor.

References
1. Mahase, E. Having a named GP doesn’t improve older patients’ continuity of care, finds study. BMJ 2019;366:l5682
2. Tammes P, Payne RA, Salisbury C, et al . The impact of a named GP scheme on continuity of care and emergency hospital admission: a cohort study among older patients in England, 2012-2016. BMJ Open 2019;9:e02910310.
3. Barker I, Steventon A, Deeny SR. Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data. BMJ. 2017;356:j84
4. Barker I, Lloyd T, Steventon A. Effect of a national requirement to introduce named accountable general practitioners for patients aged 75 or older in England:regression discontinuity analysis of general practice utilisation and continuity of care. BMJ Open. 2016;6(9):e011422.
5. Sidaway-Lee K, Gray DP, Evans P. A method for measuring continuity of care in day-to-day general practice: a quantitative analysis of appointment data. Br J Gen Pract. 2019;69(682):e356-e362.

Competing interests: No competing interests

10 October 2019
Denis Pereira Gray
Consultant
Kate Sidaway-Lee, Philip Evans, Alex Harding
St Leonard's Research Practice
Exeter, Devon