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- Page navigation anchor for Changes in patient experience associated with growth and collaboration in general practiceChanges in patient experience associated with growth and collaboration in general practice
These insights into the impact of practice size and/or collaboration on continuity of care are timely and concerning. Efforts to strengthen collaboration between practices have continued in the UK since the end of the study period, so the trend the authors report up until 2018 may well have progressed.
For at least some patients (notably the most vulnerable and complex), continuity of care has repeatedly been shown to be a key factor in the quality of primary care and the satisfaction of patients and clinicians. Evidence of the continued fall reduction in continuity as reported by patients is therefore a cause of concern, but it seems likely to be amenable to practical action in every practice.
In the early days of the NHS, the single-handed nature of general practices ensured a strongly personal (and wholly medical) model of care. With the exception of holiday periods, continuity could be 100%. Although this was valued by GPs and patients, general practice was providing continuity by default rather than by design. As we began adopting group practice and multidisciplinary approaches, surveys have pointed to a reduction in continuity. However, this can be seen not as an inherent consequence of size but simply as a failure to design continuity into our model of access.
The opportunity to improve continuity of care lies largely in the hands of practices ourselves. Ensuring that those patients who most need continuity are more consistently signposted to...
Show MoreCompeting Interests: None declared. - Page navigation anchor for Changes in patient experience associated with growth and collaboration in general practice: observational study using data from the UK GP Patient SurveyChanges in patient experience associated with growth and collaboration in general practice: observational study using data from the UK GP Patient SurveyWe read with great interest the paper written by Forbes et al.,1 which attempted to assess a patient's perspective on the growth of GP practices across the UK. We acknowledge the importance of evaluating the efficacy of growth and collaboration in general practice and would like to highlight the shortfalls of this study in attaining this goal.The measures used to analyse the significance of increased practice size were arbitrary and determined solely by the authors' considerations - this inevitably introduces bias. In addition, the simplistic analysis fails to recognise the accompanying increase in staff to cope with the changes, or the possibility that ‘newly registered’ patients only sought specific medical attention from specialist services which could not be provided by their primary GP. This means that their primary GP still retains responsibility for most of their health concerns.Additionally, several limitations such as the change in patient demographics and increase in non-responders’ rates with increased cohort size were unaccounted for. Also, it takes time to find a system that optimises both service efficiency and standard of care and for it to be reflected in clinical practice. Data collection during this time period would lead to poorer results that may not truly reflect the long-term impact of such reforms.2Competing Interests: None declared.