Measuring continuity in a small rural GP practice using the Usual Provider of Care Index

Philip Sparks; Sarah Simpson

doi:10.3399/bjgp25X742737

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 4815 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 that 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 SystmOne, we had to design our own bespoke tool. Our primary care network (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 0.54. This fits with UPC scores reported elsewhere in the literature.1 To provide more context, our GP team consists of four partners, one salaried, and one registrar all working less than full time.

These 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 multidisciplinary team 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 mortality.2 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

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1. Hull SA,
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4. et al.
(2022) Measuring continuity of care in general practice: a comparison of two methods using routinely collected data. Br J Gen Pract, DOI: https://doi.org/10.3399/BJGP.2022.0043.
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1. Pereira Gray DJ,
2. Sidaway-Lee K,
3. White E,
4. et al.
(2018) Continuity of care with doctors — a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open 8, 6, e021161.
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