New directions in policy in NHS GP contracts

Denis Pereira Gray; Kate Sidaway-Lee; Philip Evans; Nada Khan; Molly Dineen; Alexander Harding

doi:10.3399/bjgp25X741381

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Measuring continuity in a small rural GP practice using the Usual Provider of Care Index
Philip Sparks and Sarah Simpson

Published on: 22 May 2025

Published on: (22 May 2025)
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Measuring continuity in a small rural GP practice using the Usual Provider of Care Index
Philip Sparks, GP Registrar, Milton Abbas Surgery
Other Contributors:
Sarah Simpson, Digital Care Co-ordinator, Mid-Dorset PCN
I would like to support your comments about the usefulness of in-practice measurement of continuity. This is based on my recent experience of leading a quality improvement project aimed at improving continuity within our small rural practice with a list size of 4,815 patients.

After spending some time reviewing different methods of measuring continuity of care and with the support of the RCGP continuity toolkit I decided that the Usual Provider of Care (UPC) Index was best suited to our practice which uses pooled lists. The UPC is the proportion of appointments which are with the patient's usual GP, averaged across the practice population.

Within the RCGP toolkit they provide a tool to measure the UPC for any practice using EMIS. As we use System One, we had to design our own bespoke tool. Our PCN Digital Care Co-ordinator played a key role in writing this search.

We measured UPC within the last 12 months for patients with at least two appointments. Our UPC score was 53.7. This fits with UPC scores reported elsewhere in the literature¹. To provide more context our GP team consists of four partners, one salaried and one registrar all working LTFT.

This data informed a very useful practice-level discussion involving all team members. This discussion was enhanced by comparing our UPC score with the other practices in the PCN. Some key themes from this discussion were how we arrange follow-up after seeing a patient, whether we can...
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I would like to support your comments about the usefulness of in-practice measurement of continuity. This is based on my recent experience of leading a quality improvement project aimed at improving continuity within our small rural practice with a list size of 4,815 patients.

After spending some time reviewing different methods of measuring continuity of care and with the support of the RCGP continuity toolkit I decided that the Usual Provider of Care (UPC) Index was best suited to our practice which uses pooled lists. The UPC is the proportion of appointments which are with the patient's usual GP, averaged across the practice population.

Within the RCGP toolkit they provide a tool to measure the UPC for any practice using EMIS. As we use System One, we had to design our own bespoke tool. Our PCN Digital Care Co-ordinator played a key role in writing this search.

We measured UPC within the last 12 months for patients with at least two appointments. Our UPC score was 53.7. This fits with UPC scores reported elsewhere in the literature¹. To provide more context our GP team consists of four partners, one salaried and one registrar all working LTFT.

This data informed a very useful practice-level discussion involving all team members. This discussion was enhanced by comparing our UPC score with the other practices in the PCN. Some key themes from this discussion were how we arrange follow-up after seeing a patient, whether we can use triage to improve continuity, and how we can use MDT discussions to improve continuity using a team-based approach.

Another key component of this project was understanding whether our staff understood the value of continuity. Interestingly, a third of staff at the practice were unaware that continuity of care has been associated with reduced mortality². Reflecting on our UPC as a practice provided an opportunity to share this evidence with staff to help foster a culture of continuity.

To summarise, our experience has been that measuring continuity in practice has been an effective way of informing practice-level reflection on our performance. It has formed the basis of upcoming work to improve the continuity of care we provide. It would be very helpful if a tool for measuring continuity was made available to all practices as part of the proposed contract changes.

References

1. Hull SA, Williams C, Schofield P, et al. Measuring continuity of care in general practice: a comparison of two methods using routinely collected data. Br J Gen Pract 2022, 27;72(724):e773-e779. doi: 10.3399/BJGP.2022.0043.
2. Pereira Gray DJ, Sidaway-Lee K, White E, et al. Continuity of care with doctors- a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open 2018, 28;8(6):e021161. doi: 10.1136/bmjopen-2017-021161.
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Competing Interests: None declared.