The power of personal care: the value of the patient–GP consultation

RESEARCH EVIDENCE ON CONTINUITY OF CARE

Two recent systematic reviews show that continuity of care with doctors, including within primary care, is associated with reduced mortality in patients.^3,4 In addition, GP continuity achieves significantly fewer hospital admissions and lower costs across whole healthcare systems.^5,6

GP empathy has been associated with patient satisfaction, and a sense of security for patients, fewer physical complications in diabetes, and reduced all-cause mortality.^7,8 Such is the remarkable power of personal care: kindness in the consultation counts.

However, these studies were based, pre- COVID-19, on face-to-face GP consultations, which are now much reduced. Moreover, there is research evidence that GPs are significantly less effective when consulting on the telephone or when triaging requests from patients for new consultations. Also, GPs commonly comment that remote consultations are much easier to conduct when there is continuity of care.

General/family practice is an international discipline and there is vast experience abroad about generalist practice in the front-line of health systems. An international consensus exists that 10-minute consultations are too short, and the UK is an outlier with so many short consultations.⁹ Additionally, continuity of GP care is lower in the UK than in many other countries from Canada to Germany, so patients, GPs, and the NHS may be missing out.

WHAT SHOULD WE BE DOING?

What is now the best way forward? First, as longer consultations are significantly more patient centred the average length of consultations should be set at 15 minutes, especially if these are undertaken remotely.¹⁰ Longer consultations are also significantly less stressful for GPs. Anecdotal reports show that in some practices GPs are now in contact with patients at only 6-minute intervals. This retrograde step is concerning, as this pace, for either triage or consulting, is simply too fast and probably not safe for patients or GPs. Burnout in GPs was as high as 33% pre-COVID-19 and may get worse with new pressures. It is much more serious than policymakers realise as it generates doctor distress, loss from the profession, and death by suicide. It is also associated with increased medical errors. In the US, the cost of medical burnout has been estimated at 4.6 billion USD per annum.¹¹

Second, practices need access to good quality data. Practice management is a substantial skill influencing both the quality of care for patients and the wellbeing of GPs and primary care staff. In the absence of consistent coding of GP activity general practices will not be able to fully assess the cost-effectiveness of these new models for different patient populations and plan ahead. How many telephone/video/face-to-face/email consultations in a year? How many of these are for the same medical problem? What is the average consultation duration? What is the level of continuity within the practice? What is the difference between triage and consultation? In this age of information, GPs need easy access to data about their own practice, which may differ greatly from neighbouring practices. Much effort has been made in aggregating national GP data in big databases and in NHS Digital, the next step is practice-specific, high quality, consistently coded data. This would allow both research at national level and informed decisions at practice level.

The pandemic has resulted in some radical changes in the ways GPs work. Critical thinking is needed when deciding the best way of tailoring these new ways of working to patient needs. Future success will depend on learning from research evidence, reflecting on own practice, and meeting international norms for consultations so that GPs in the UK can maximise for their patients their remarkable power of personal care.