Effect of a national requirement to introduce named accountable general practitioners for patients aged 75 or older in England: regression discontinuity analysis of general practice utilisation and continuity of care

Abstract

ObjectiveTo assess the effect of introducing named accountable general practitioners (GPs) for patients aged 75 years on patterns of general practice utilisation, including continuity of care.DesignRegression discontinuity design applied to data from the Clinical Practice Research Datalink to estimate the treatment effect for compliers aged 75.Setting200 general practices in England.Participants255 469 patients aged between 65 and 85, after excluding those aged 75.InterventionFrom April 2014, general practices in England were required to offer patients aged 75 or over a named accountable GP. This study compared having named accountable GPs for patients aged just over 75 with usual care provided for patients just under 75.OutcomesNumber of contacts (face-to-face or telephone) with GPs, longitudinal continuity of care (usual provider of care, or UPC, index), number of referrals to specialist care and numbers of common diagnostic tests. Outcomes were measured over 9 months following assignment to a named accountable GP and for a comparable period for those unassigned.ResultsThe proportion of patients with a named accountable GP increased from 3.5% to 79.8% at age 75. No statistically significant effects were detected for continuity of care (estimated treatment effect 0.00, 95% CI −0.01 to 0.02) or the number of GP contacts per person (estimated treatment effect −0.11, 95% CI −0.31 to 0.09) over 9 months. No significant change was seen in the number of referrals, blood pressure or HbA1c diagnostic tests per person. A statistically significant treatment effect of −0.05 cholesterol tests per person (95% CI −0.07 to −0.02) was estimated; however, sensitivity analysis indicated that this effect predated the introduction of named accountable GPs.ConclusionsContinuity of care is valued by patients, but the named accountable GP initiative did not improve continuity of care or change patterns of GP utilisation in the first 9 months of the policy.

Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data

“…54 In England, one of the few recent national initiatives to improve the continuity of care in general practice was the mandatory introduction of named accountable general practitioners, 55 but this had no discernible impact on longitudinal continuity of care, at least for patients aged 75 over the first nine months. 56 Therefore, approaches are needed to improve continuity of care in general practice.…”

Tackling multimorbidity in primary care: is relational continuity the missing ingredient?

“…For example, a recent policy aimed at assigning a named GP for all patients aged 75 or older in England, in order to improve relational continuity and care outcomes, was not successful. 14 Similarly, and as primary care teams expand, clinicians other than GPs (such as practice nurses or community matrons) are increasingly taking similar roles…”

Predicting declines in perceived relationship continuity using practice deprivation scores: a longitudinal study in primary care

“…20 In the first 9 months after these requirements were introduced there was no improvement in continuity. 21 Socioeconomic deprivation measures the disadvantage of an individual or group relative to the local community or wider society, 22 and, thus, is an indicator of socioeconomic position. Across the world, those who are disadvantaged in this way suffer higher rates of adverse health problems, such as suicide, heart disease, lung disease, obesity, and diabetes, and are more likely to have shorter lives.…”