Continuity and having your own GP is always mentioned in plans for General Practice and always noted as something patients value. But it is treated as an aspiration we hope for, not an essential. But what if continuity is actually a tool that improves our effectiveness way more than it costs? What if neglecting it actually makes us achieve less?
Continuity is like a chef having an hour to make a dish compared with five chefs having 12 minutes each and only using post-its to communicate.
When you see and hear and touch a patient your memory has far more information about them than you can put in the notes. When you see them again you can spot much more subtle differences than someone just reading your notes.
When you see a patient, you think through what you are planning you remember all the reasons for your actions. So when you see them again you can continue where you left off rather than having to work everything out again.
When you see a patient, you come to a shared understanding about what you think is going. Again, your memory has far more information about what you have agreed with your patient than you can put in the notes.
Added together this gives you a huge time saving and allows you to do more in a consultation. And it is cumulative, the more the patient sees the same person, the more effective the consultations.
Is Continuity hard to achieve in practice?
Making sure patients see the same GP about the same problem is often considered to be too much effort. And therefore, although it is an aspiration, it is allowed to wither in day-to-day care. But, if you treat it as an essential productivity tool, how would you achieve it?
Patients remember who they last saw and want to see the same person for follow up. This is an obvious human behaviour. So simply arranging your appointment system so it is straightforward for a patient to choose whom they see will automatically improve continuity.
Explaining to your receptionists how much continuity helps you do your job will make them want to take the time to get the patients to see the right person, rather than just putting them in the first appointment they find. This does require that your receptionists feel valued and are not rushed off their feet.
Clinicians also need to appreciate the difference that continuity makes and to believe it will make their lives easier in the long run. They need to encourage patients to come back to them personally and also, if necessary, to squeeze in their patients as extras because they know the problem. They need to know that if they go the extra mile to get more out of each consultation then they will reap the reward of having fewer consultations to do.
Abandoning Bureaucratic processes, like telling patients their named GP or constraining them to a personal list frees up staff time to find the best doctor for the patient. These processes may give the appearance of improving continuity, but they ignore the fact that patients and staff will sort it out themselves.
Is GP at scale anti-continuity?
Expanding routine consultations to early mornings, evenings and weekends is put forward as something which improves patient access to appointments. Clinicians are expected to work regular shifts and have time off during the working week so in theory, continuity is not affected.
The problem is that no-one wants to work while their friends and family are socialising. So, these anti-social shifts are done on a rota or by locum doctors. Patients are pushed towards these Extended Access appointments for political reasons and rarely see the same doctor.
GP at scale makes a virtue out of local practices being amalgamated and centralising or automating appointment booking. This impersonal booking service is unlikely to prioritise continuity. Although GP at scale doesn’t make it impossible for a patient to see the same doctor, it does seem to break some of the mechanisms by which patients, receptionists and clinicians create continuity.
If continuity is an essential tool and GP at scale breaks continuity would we be better off staying in our local practices and wait for the next re-disorganisation?