How repeat visits to the same GP can save cost and boost healthcare outcomes

Stefan Scholtes has for 2 decades researched ways to improve healthcare – by GPs, practices and hospitals – including studies based in England, Germany and the US.

More recently, in 3 studies, Stefan has focused not only on access to care – as important as that is – but continuity of care, specifically seeing the same GP on a regular basis. The findings are striking, and very instructive.

“Continuity of care is crucial,” says Stefan, Dennis Gillings Professor of Health Management and Director of the Cambridge Centre for Health Leadership and Enterprise at Cambridge Judge Business School. “At a time when healthcare budgets are under severe stress, in the NHS in England and elsewhere, our research finds big benefits from care continuity for patients, doctors, practices and hospitals.”

How to reduce doctor workload while improving patient outcomes

Among such research, a study co-authored by Stefan and other academics in the UK, Singapore and the US created a model showing that patients seeing the same doctor on each visit could have a doubly beneficial effect: significantly reducing doctor workload while improving patient outcomes and health.

The reduction in doctor workload reflects an 18% longer interval between GP visits for patients who regularly see the same doctor, and these results are magnified for older patients, those with mental health problems and multiple chronic conditions.

“We estimate that the total consultation demand in our sample could have fallen by up to 5.2% had all practices offered continuity of care at the level of the top decile of practices while prioritising patients expected to yield the largest productivity benefits,” says the study in the journal Management Science, based on data from more than 10 million consultations in 381 English primary care practices over 11 years. 

Seeing the same GP leads to fewer follow-up appointments in hospitals and doctor practices

A follow-up study has broader insights into the benefit of continuity of GP care, finding that seeing the same GP can reduce workload not only for individual GPs but also for practices and hospitals – because such continuity results in fewer follow-up appointments in hospital Accident and Emergency (A&E) departments and in doctor practices.

“With continuity, including from acute consultations, GPs gain better understanding of the patient and the context of their lives,” says the research published in the British Journal of General Practice (BJGP). “This may allow GPs to evaluate risk with more precision and deal with more problems in a single consultation, hence avoiding unnecessary emergency hospital admissions and A&E use while also making more referrals.”

Both studies were based on data from the Clinical Practice Research Datalink, containing anonymised data from 222 practices across England. The BJGP study breaks GPs into 3 categories – a patient’s regular GP, other GPs in the same practice, and GP locums (who temporarily fill in at a practice). After adjusting for age and other patient-level risk factors, the research found that the mean re-consultation interval for patients who regularly see their own GP was 61 days compared to 56 days for patients who see other GPs.

Continuity of care also eliminates one avoidable consultation for every 10 consultations

“This equates to roughly one avoidable consultation for every 10 consultations if the consultation was with the regular GP,” says the research, which found that that patients seeing their regular GP were less likely (22% for non-regular GPs and 30% for locums) to attend emergency departments in the same week and significantly more likely to be referred to a specialist.  

Says Stefan:

“We know that patients are having difficulties in getting GP appointments, and we’re seeing long waiting times at A&E departments. It’s encouraging that this data shows that if general practices help patients to see their regular GP more often, fewer consultations and attendances at emergency departments are needed overall. Making efforts for patients to see the same GP regularly could help patients by reducing pressure in both general practices and emergency departments.” 

However seeing a different GP means patients are less likely to become dependent on opioids

GP continuity is a cornerstone of effective primary care, fostering trust and better patient outcomes. However, there are situations where a second opinion can be crucial.

Using a nationwide US database of medical and pharmaceutical claims, Stefan and colleagues from the US and Singapore examined opioid prescriptions and subsequent dependence. Their study focused on patients who had not been prescribed opioids for at least 6 months and then received an initial opioid prescription. They found that when follow-up visits were conducted by a different doctor, one who had not prescribed the opioid, patients were less likely to develop long-term opioid dependence.

This fresh perspective helped avoid anchoring bias in the original prescribing decision and led to a 31% reduction in long-term opioid use 12 months after the initial prescription. These findings highlight the delicate balance between continuity and the strategic involvement of colleagues in specific situations.

Continuity should not extend to nurses working too many consecutive days

And when it comes to nursing care, in particular intensive care, a different type of continuity can have negative implications. Hospitals often need staff to work additional consecutive days, and while this means that patients may see the same hospital nurse on a more regular basis, research co-authored by Stefan finds that patient outcomes decline when there is an increase in the average number of consecutive days worked by a nursing team.

“Longer consecutive working periods harmfully affect care quality, especially during staffing shortages. The detrimental impact on long periods of consecutive days worked is particularly pronounced in patients with less complex medical needs,” says the research published in the journal Manufacturing and Service Operations Management, which is based on data from neonatal intensive care units in Germany.

The research recommends limiting and monitoring the team-average number of consecutive working days alongside daily staffing levels, and for policymakers to consider limits on the number of consecutive working days for intensive care nurses.

Why the NHS is starting to separate routine and non-routine services

Beyond continuity of care, other recent areas of research focus for Stefan include the reorganisation of general hospitals into separate divisions for routine and non-routine services. This is a strategy that is now increasingly pursued in the NHS.

“Our analysis suggests that routine and complex patients would benefit from a hospital organisation with a multi-specialty hub for emergency and non-routine elective services at its core, complemented by organisationally separate disease-focused hospitals-within-hospitals for routine services,” says a study co-authored by Stefan.