Continuity in UK general practice: a multilevel model of patient, doctor and practice factors associated with patients seeing their usual doctor.

BACKGROUND: Personal continuity is a 'core value' for UK general practice, but often appears ignored by organizational change.
OBJECTIVES: The aim of the present study was to examine practice, GP and patient factors associated with personal continuity of care.
METHODS: A cross-sectional survey was carried out of 25 994 people aged >15 consulting over a 2-week period in 53 general practices in four regions of the UK. The outcome measure was whether or not the patient was seeing their usual or regular doctor.
RESULTS: Compared with the smallest quintile of practices, the odds ratios [95% confidence interval (CI)] for patients seeing their usual doctor for the two largest quintiles of list size (6337-11 036 and >11 037) were 0.24 (0.12-0.46) and 0.19 (0.10-0.37). Patients in the five practices with personal list systems were more likely to be seeing their usual doctor (odds ratio 3.27, 95% CI 1.87-5.70). Older patients were considerably more likely to be seeing their usual doctor. Young men were less likely, but by middle age there were no differences between men and women. Compared with patients who only wished to discuss a new or urgent physical problem, those wishing to discuss psychological (odds ratio 2.28, 95% CI 2.01-2.58) or longstanding physical problems (odds ratio 1.92, 95% CI 1.78-2.08) were more likely to be seeing their usual doctor.
CONCLUSIONS: In this study, list sizes over approximately 6000-6500 were associated with marked reductions in personal continuity. If GPs are serious about the importance of personal continuity, then the size of the primary care team needs to be examined. There may be potential in separating the administrative functions of the practice from the clinical functions of the primary care team.