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Seeing the same GP each time would improve health and reduce doctors’ workload, University of Cambridge study finds

If patients were able to see the same doctor each time they visited a GP practice, it would improve their health and significantly cut the healthcare workload, research has shown.

The University of Cambridge and INSEAD business school analysed more than 10 million anonymised consultations in 381 English primary care practices over 11 years for the study, which is one of the largest of its kind.

A GP takes a patient's blood pressure
A GP takes a patient's blood pressure

They found a long-term relationship between a patient and doctor was beneficial for both.

Patients waited on average 18 per cent longer between visits, compared to those who saw a different doctor, and the productivity benefit of the model - known as continuity of care - was most notable among older patients, those with chronic conditions and individuals with mental health conditions.

While acknowledging it cannot always be possible for a patient to see their regular GP, the researchers say the number of consultations would fall by five per cent if all practices in England adopted the level of continuity of care seen in the best 10 per cent of practices.

That is significant against the backdrop of the enormous strain in primary care - and the projected 15 per cent increase needed in GP numbers in the UK.

Dr Kajaria-Montag, the study’s lead author, who is now based at the Kelley School of Business at Indiana University 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.”

Roughly half of all appointments at English GP practices are with a patient’s regular doctor, but that proportion has been steadily declining over the past decade amid increasing strain.

“You can measure the productivity of GP surgeries in two ways: how many patients can you see in a day, or how much health can you provide in a day for those patients,” said co-author Professor Stefan Scholtes, from Cambridge Judge Business School. “Some GP surgeries are industrialised in their approach: each patient will get seven or 10 minutes before the GP has to move on to the next one.”

They used statistical models to account for confounding and selection bias, and restricted the sample to consultations with patients who had at least three consultations over the past two years, finding continuity of care enables the time between visits to increase significantly, with no meaningful difference in the length of consultation.

“The impact is substantial: it could be the equivalent of increasing the GP workforce by five per cent, which would significantly benefit both patients and the NHS,” said Prof Scholtes. “Better health translates into less demand for future consultations. Prioritising continuity of care is crucial in enhancing productivity.

“A regular doctor may have a larger incentive to take more time to treat her regular patients thoroughly than a transactional provider.“Getting it right the first time will reduce her future workload by preventing revisits, which would likely be her responsibility, while a transactional provider is less likely to see the patient for her next visit.”

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 per cent while those who answered ‘never or almost never’ increased from 10 to 19 per cent.

Dr Victoria Tzortziou-Brown, vice chairwoman of the Royal College of GPs, said: “Continuity of care is highly valued by GPs and patients alike.

“We already know it is beneficial for patients, particularly those with complex health needs, and we know it has benefits for the NHS – and it’s encouraging to see that this study has found it can also improve GP workload. Studies such as this one are very important for informing future policy and practice.

“Currently, the intense workload and workforce pressures GPs are facing – as well as political agendas prioritising speedy access to GP services above all else – greatly limit the level of continuity we can offer.

“The average number of patients per fully qualified GP is now 2,294, meaning each GP is, on average, responsible for 260 more patients than they were six years ago.

“This is unsustainable and makes guaranteed access to the same GP for every patient practically impossible. However, it would be important that continuity of care is prioritised for those who need it the most.

“Before we can offer greater levels of continuity, we need to address the clear gaps in our workforce – we’ve lost 642 fully qualified, full-time GPs in the past five years – and provide support for the myriad of other challenges the profession faces including the rising rates of patients presenting with chronic, complex health conditions.”

An NHS spokesperson said: “Continuity of care with a GP or health professional familiar with a person’s care can be really important, but with record demand for services it can be difficult for practices to offer this for every patient.

“The NHS Long Term Workforce Plan offers a vital opportunity to grow the primary care workforce to meet increased demand, including increasing GP training places by 50%, to support general practice teams to provide continuity of care, especially for those who need it most such as older people or those with complex health needs.”

A Department of Health and Social Care spokesperson said: “Continuity of care is important, alongside speed and convenience of access. All patients must be assigned a named GP, and practices must endeavour to comply with all reasonable requests from patients to see a particular GP or other healthcare professional.”

The study, published in Management Science, used data from the Clinical Practice Research Datalink.

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