Re: Can general practice still provide meaningful continuity of care?

Agreement: 
I Agree
Body: 

Dear Editor

it is useful to see reviews of the importance of GP continuity. But it is unhelpful that two major issues were missed or misrepresented by the review.

The first mistake is the focus on continuity for all. Some patients need continuity far more than others. Many studies simply ignore this issue by analysing the results across all patients. But this does not demonstrate that focussing continuity on the subsets who need it most would not be a useful step especially in a resource-constrained environment like the UK. Demanding universal continuity based on those studies leads to a policy sledgehammer when a nutcracker would be better.

The second problem is the casual unreferenced claim that “Targets for speed of access and encouragement of on- the-day teams and remote triage have reduced continuity and undervalued GPs”. But there is no solid evidence that either speed of access or remote triage hurt continuity if implemented well.

The typical traditional model of making a GP request–phone reception and hope they find any slot with someone as soon as possible–has no room for decisions that improve continuity even for those who need it most. But well implemented remote triage can easily do better. In good systems, the patient is asked what mode of consultation they want (phone, online, face to face) and whether they want to see a specific staff member. This facilitates the practice to allocate them as appropriate (including assessment of their clinical issues and history). This makes it far easier to enhance continuity on the basis of both need and preference (patients might sometimes choose speed over continuity). Hence why evidence shows the increase in remote consultation has not hurt continuity (https://bmjopen.bmj.com/content/13/11/e075152.full). Not all triage systems work this way, but the best do.

Ignoring the two points leads the article to make weak suggestions. yes, measuring continuity can help. But the best approaches to that are found in total triage systems taking patient preferences into account and providing real-time feedback on the demand for and deliver of continuity.

Changing the detailed local processes for handling and responding to patient demand is the best and fastest way to enhance continuity. Far better than the blunt sledgehammers of national policy . By denying the benefit of remote triage systems and pushing for blunt policies, the analysis misses the best way to fix the problem.

No competing Interests: 
Yes
The following competing Interests: 
Electronic Publication Date: 
Friday, November 24, 2023 – 14:02
Workflow State: 
Released
Full Title: 

Re: Can general practice still provide meaningful continuity of care?

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Last Name: 
black
First name and middle initial: 
stephen
Address: 
bedford, uk
Occupation: 
data scientist
Affiliation: 
black box data science
BMJ: Additional Article Info: 
Rapid response
Twitter: 
@sib313

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