Access & Continuity Londonwide LMCs 12 th February 2014 George Freeman Emeritus Professor of General Practice Imperial College London

Access & Continuity

Londonwide LMCs 12th February 2014George Freeman

Emeritus Professor of General PracticeImperial College London

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relationship continuity

continuity is about care of individuals over time- three types

• Relationship (or interpersonal)

• Management (or coordination)

• InformationalEveryone wants management & informational continuity but GPs face two ways on relational continuity

12th Feb 2014Access & Continuity - George Freeman for Londonwide LMCs

Access & Continuity - George Freeman for Londonwide LMCs

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ambivalence about relationship continuity

• it’s a cornerstone of general practicebut• we haven’t time for a personal

service these days - especially given current access pressures

12th Feb 2014


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benefits of relationship continuity

• satisfaction for patients and staff• most patients want it – more than they can

get– especially in London

• lower costs – admissions (emergency & elective)– tests– referrals

• better problem recognition• easier care of people with multimorbidity12th Feb 2014


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why continuity is essential for generalists

seeing the same doctor• promotes mutual trust– encourages a therapeutic relationship

• fills in generalist picture with– context– history & knowledge – tacit as well as

recorded– personal values and priorities

• compensates for less specialist expertise

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multi-morbidity care enhanced by • shared experience of identifying and

coping with problems over time• familiarity with relevant factors for

prioritising care optionsfor example• back in 1980 Howie found that if mothers

were on psychotropic drugs then their children were more likely to get antibiotics for URTI !

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multimorbidity

• increasingly prevalent• more prevalent with advancing age

but most multimorbidity seen in under 65s• associated with deprivation

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access & continuity -1

• patients want both but it’s partly a trade-off!

• actually most patients understand this– seeing the same doctor is prioritised for

serious and chronic conditions– by all age groups – and patients will wait several days to

see the right doctor– any clinician will do for short-term or

minor problems12th Feb 2014


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access & continuity - 2

• not all a trade-off – better continuity can both reduce demand and make it more appropriate

• practices can improve continuity to manage access pressures– reduces repeat consultations– patients happier to wait a few days

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how to improve relationship continuity

• receptionists & appointments– prioritising and training

• telephone and e-consultation– best for follow-up – and with known

doctor

• in the consulting room– set an example

• smaller teams for large practices– too much choice is confusing

12th Feb 2014


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discussion questions

what are the issues for continuity in your practice? how to address these?for example

• personal availability and longer opening hours?

• part-timers & continuity?• continuity and commissioning?• QOF and availability?12th Feb 2014


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assess your own continuity!

How much do patients actually see the same doctor in your practice? - for a simple guide on how to audit your own performance from your records system, we suggest the following link to the work of colleagues in the University of Bristol

http://www.bristol.ac.uk/primaryhealthcare/resources/continuityaudit/

12th Feb 2014



Documents

Access & Continuity Londonwide LMCs 12 th February 2014 George Freeman Emeritus Professor of General Practice Imperial College London