Improving access and continuity in general practice: practical and policy lessons

Background Improved access to general practice is seen by policy makers as essential to address patient expectations and reduce demand for A&E, but little is known about its impact on continuity. Aim This study examined the impact of policies to improve access on continuity and described practical approaches to delivering both improved access and continuity. What is the evidence that continuity within general practice benefits patients, or is important to health professionals? Which primary care patients are more likely to want continuity of care, and how likely are they to report receiving it? How might policy initiatives to improve access affect continuity of care, and to what extent is there evidence of this? What factors might best support continuity of care in the context of improved access? Method A rapid literature review, semi-structured interviews with providers and one commissioner, and two expert workshops were combined, with quantitative analysis of practice-level data and 2017 GP Patient Survey data. Results Various sociodemographic and clinical factors shape patients’ desire for, and ability to obtain, continuity. We will present the limited evidence available on the impact of improved access on continuity and describe practical approaches to support continuity across three broad areas: service design, workforce development, and technology. Conclusion It is possible to offer both improved access and continuity if this is an explicit objective of service redesign. Commissioners and policymakers should attach greater priority to continuity and commission further research to understand the longer-term impacts of improved access and working at scale on continuity, patient experience, and wider outcomes.