Development of a novel GP continuity measurement for practices without personal lists: a two-practice pilot of the modified SLICC

Kate Sidaway-Lee; Denis Pereira Gray; Jason Fearn-Smith; Alastair Buick; Serge Engamba; Nada Khan; Philip Hugh Evans

doi:10.3399/BJGP.2025.0624

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Figure 1. Results for each practice for 1 year (April 2024–March 2025) for SLICC (monthly), mSLICC (monthly), UPC (rolling cumulative 1 year^a), and BB (rolling cumulative 1 year^a). ^aTakes in the 12 months up to, and including, the month named. BB = Bice–Boxerman Continuity of Care Index. mSLICC = modified St Leonard’s Index of Continuity of Care. SLICC = St Leonard’s Index of Continuity of Care. UPC = Usual Provider of Care Index.

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Table 1. Practice A: numbers and percentages of appointments and patients included in the various continuity measures for April 2024–March 2025^a

Group on 31 March 2025	Appointments							Patients with appointments
	Total, n	Included in mSLICC			Included in UPC and BB			Total	Included in mSLICC		Included in UPC and BB
	Total, n	n	%	P-value, χ²	n	%	P-value, χ²	Total	Mean %	P-value, t-test	n	%	P-value, χ²
Whole population	17 312	12 695	73.3		13137	75.9		5369	71.2		2388	44.5
Top decile of GP appointment numbers over 3 years	6133	6098	99.4	<0.001	5961	97.2	<0.001	834	99.6	<0.001	727	87.2	<0.001
Lowest nine deciles of GP appointment numbers over 3 years	11 179	6597	59.0	<0.001	7176	64.2	<0.001	4535	58.9	<0.001	1661	36.6	<0.001
Aged ≥65 years	5726	4912	85.8	<0.001	4942	86.3	<0.001	1329	84.3	<0.001	776	58.4	<0.001
Aged <65 years	11 586	7783	67.2	<0.001	8195	70.7	<0.001	4040	65.4	<0.001	1612	39.9	<0.001
Male	6921	4782	69.1	<0.001	4980	72.0	<0.001	2331	66.9	<0.001	930	39.9	<0.001
Female	10 391	7913	76.2	<0.001	8157	78.5	<0.001	3038	74.1	<0.001	1458	48.0	<0.001
Severe or moderate frailty (eFI)	3027	2881	95.2	<0.001	2856	94.4	<0.001	474	94.4	<0.001	359	75.7	<0.001
Mild or non-frail (eFI)	12 576	8919	70.9	<0.001	9195	73.1	<0.001	4208	69.3	<0.001	1808	43.0	<0.001
Aged <18 years	1709	895	52.4	<0.001^b	1086	63.5	<0.001^b	687	50.4	<0.001^b	221	32.2	<0.001^b

^aThe number of patients included in the mSLICC is not given as some patients may be included in some months (when they have a regular GP) and not others; the mean of the percentage of all patients with appointments each month is given instead. The SLICC includes all appointments. ^bCompared with whole adult population. BB = Bice–Boxerman Continuity of Care Index. eFI = electronic Frailty Index. mSLICC = modified St Leonard’s Index of Continuity of Care. UPC = Usual Provider of Care Index.

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Table 2. Practice B: numbers and percentages of appointments and patients included in the various continuity measures for April 2024–March 2025^a

Group on 31 March 2025	Appointments							Patients with appointments
	Total, n	Included in mSLICC			Included in UPC and BB			Total	Included in mSLICC		Included in UPC and BB
	Total, n	n	%	P-value, χ²	n	%	P-value, χ²	Total	Mean, %	P-value, t-test	n	%	P-value, χ²
Whole population	11 815	7145	60.5		7895	66.8		4555	59.1		1708	37.5
Top decile of GP appointment numbers over 3 years	3097	3037	98.1	<0.001	2991	96.6	<0.001	522	98.3	<0.001	458	87.7	<0.001
Lowest nine deciles of GP appointment numbers over 3 years	8718	4108	47.1	<0.001	4904	56.3	<0.001	4033	47.3	<0.001	1250	31.0	<0.001
Aged ≥65 years	3103	2307	74.3	<0.001	2299	74.1	<0.001	1062	73.7	<0.001	503	47.4	<0.001
Aged <65 years	8712	4838	55.5	<0.001	5596	64.2	<0.001	3493	53.8	<0.001	1205	34.5	<0.001
Male	4685	2501	53.4	<0.001	2899	61.9	<0.001	1972	52.2	<0.001	648	32.9	<0.001
Female	7130	4644	65.1	<0.001	4996	70.1	<0.001	2583	63.7	<0.001	1060	41.0	<0.001
Severe or moderate frailty (eFI)	831	722	86.9	<0.001	739	88.9	<0.001	186	85.9	<0.001	124	66.7	<0.001
Mild or non-frail (eFI)	9300	5647	60.7	<0.001	6079	65.4	<0.001	3673	59.4	<0.001	1344	36.6	<0.001
Aged <18 years	1684	776	46.1	<0.001^b	1077	64.0	<0.001^b	696	44.8	<0.001^b	240	34.5	<0.001^b

^aThe number of patients included in the mSLICC is not given as some patients may be included in some months (when they have a regular GP) and not others. The mean of the percentage of all patients with appointments each month is given instead. The SLICC includes all appointments. ^bCompared with whole adult population. BB = Bice–Boxerman Continuity of Care Index. eFI = electronic Frailty Index. mSLICC = modified St Leonard’s Index of Continuity of Care. UPC = Usual Provider of Care Index.

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Table 3. Practice A: continuity measures for the whole practice population and comparisons between patient groups

Group on 31 March 2025	mSLICC		SLICC		UPC		BB
Group on 31 March 2025	%	P-value, χ²	%	P-value, χ²	Mean	P-value, t-test	Mean score	P-value, t-test
Whole population	52.0		57.1		0.63		0.41
Top decile of GP appointment numbers over 3 years	51.8	0.70	56.3	0.15	0.61	0.005^a	0.41	0.44
Lowest nine deciles of GP appointment numbers over 3 years	52.1	0.70	57.5	0.15	0.64	0.005^a	0.42	0.44
Aged ≥65 years	54.9	<0.001^a	58.6	0.003^a	0.64	0.37	0.43	0.13
Aged <65 years	50.1	<0.001^a	56.3	0.003^a	0.63	0.37	0.41	0.13
Male	53.4	0.01^a	58.3	0.008^a	0.65	0.009^a	0.43	0.02^a
Female	51.1	0.01^a	56.3	0.008^a	0.62	0.009^a	0.40	0.02^a
Severe or moderate frailty (eFI)	53.0	0.61	56.9	0.04^a	0.62	0.03^a	0.41	0.17
Mild or non-frail (eFI)	53.6	0.61	58.9	0.04^a	0.65	0.03^a	0.43	0.17
Aged <18 years	32.4	<0.001^a,b	43.4	<0.001^a,b	0.51	<0.001^a,b	0.26	<0.001^a,b

^aStatistically significant. ^bCompared with whole adult population. BB = Bice–Boxerman Continuity of Care Index. eFI = electronic Frailty Index. mSLICC = modified St Leonard’s Index of Continuity of Care. SLICC = St Leonard’s Index of Continuity of Care. UPC = Usual Provider of Care Index.

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Table 4. Practice B: continuity measures for the whole practice population and comparisons between patient groups

Group on 31 March 2025	mSLICC		SLICC		UPC		BB
Group on 31 March 2025	%	P-value, χ²	%	P-value, χ²	Mean	P-value, t-test	Mean	P-value, t-test
Whole population	25.9		25.3		0.50		0.23
Top decile of GP appointment numbers over 3 years	26.2	0.58	26.9	0.02^a	0.48	0.003^a	0.24	0.76
Lowest nine deciles of GP appointment numbers over 3 years	25.6	0.58	24.7	0.02^a	0.51	0.003^a	0.23	0.76
Aged ≥65 years	32.9	<0.001^a	33.6	<0.001^a	0.55	<0.001^a	0.29	<0.001^a
Aged <65 years	22.5	<0.001^a	22.3	<0.001^a	0.48	<0.001^a	0.21	<0.001^a
Male	29.9	<0.001^a	27.1	<0.001^a	0.52	<0.001^a	0.27	<0.001^a
Female	23.7	<0.001^a	24.1	<0.001^a	0.49	<0.001^a	0.21	<0.001^a
Severe or moderate frailty (eFI)	31.3	0.013^a	32.4	<0.001^a	0.52	0.85	0.26	0.50
Mild or non-frail (eFI)	26.9	0.013^a	26.0	<0.001^a	0.51	0.85	0.25	0.50
Aged <18 years	13.1	<0.001^a,b	17.8	0.001^a,b	0.42	<0.001^a,b	0.14	<0.001^a,b

^aStatistically significant. ^bCompared with whole adult population. BB = Bice–Boxerman Continuity of Care Index. eFI = electronic Frailty Index. mSLICC = modified St Leonard’s Index of Continuity of Care. SLICC = St Leonard’s Index of Continuity of Care. UPC = Usual Provider of Care Index.

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