Continuity predicts mortality, hospitalisation, and OOH care

Length of continuity with a GP is strongly associated with less need for acute hospitalisations and lower mortality, according to new research on GP continuity. This study included 4.5 million patients and their named GPs. It found a strong association between continuity and patient outcomes: mortality was 25% lower when the GP–patient relationship was greater than 15 years versus 1 year. Also, use of out-of-hours (OOH) services was lower, and acute hospitalisations were also lower. There was a dose-dependent relationship, in that increased continuity meant better outcomes. The authors conclude that this association of continuity and patient outcomes is probably causal, indicating the importance of continuity for patients' health.

Long COVID: recognition, diagnosis, and management

Recommendations for the investigation and management of long COVID are that specific alternative diagnoses and underlying conditions should be sought. Important alternative diagnoses include pulmonary embolism, diabetes and thyroid disorder (all of which may be triggered by COVID-19). Many patients with long-COVID symptoms have features of autonomic system dysfunction (such as Postural Orthostatic Tachycardia Syndrome or ‘disordered’ breathing patterns), allergic type responses (termed ‘mast-cell disorder’), or inflammation of the heart or nervous system. Recognising and treating these conditions can greatly assist patients in recovery. Exclusion of heart inflammation is important prior to increasing physical activity in patients with chest pain or lowered blood oxygen saturation. Careful pacing of activity is needed to avoid relapse.

Cancer detection via primary care urgent referral

Primary care urgent referrals for suspected cancer have more than doubled in the last decade to over 2 million per year. This increase has had significant impacts on cancer detection and improved patient outcomes. Higher cancer detection via 2-week wait (2WW) referrals was associated with larger practices and those with younger GPs, though the relationship with GP age was attenuated. Of concern are decreases in 2WW referrals during the COVID-19 pandemic and potential disparity in cancer detection, with lower rates in more deprived populations. This study of urgent referral for cancer detection included all general practices in England (>7000) over 10 years from 2008/9 to 2018/19.