Ensuring patients experience personal continuity dependent on the characteristics of the practice and the patient and, in particular, on practice size, researchers report today.

Interviews with ten practices in The Netherlands, combined with real-life data from 269,478 patients from 48 Dutch practices between 2013 and 2018, found that a larger number of usual GPs working in a practice and a larger percentage of patient contacts with locum GPs were associated with lower personal continuity.

Writing in the British Journal of General Practice, the team, led by Dr Marije te Winkel, associate professor at the Department of General Practice, Amsterdam Public Health Research Institute, said higher personal continuity was also dependent on how long a patient had been registered with a GP, as well as older age and number of chronic conditions. Using multilevel linear regression analyses, four different personal continuity outcome measures were calculated relating to eight practice and 12 patient characteristics, which was followed by a thematic analysis of semi- structured interviews with ten GPs to include their views on factors contributing to personal continuity.

The interviews with GPs highlighted three key themes affecting personal continuity: team composition, practice organisation, and the personal views of the GPs. The findings should help clinicians to improve targets in their own practices, the researchers say.

The report says personal continuity implies familiarity and mutual confidence between the patient and doctor over repeated appointments. While there are multiple benefits to personal continuity, such as fewer emergency department visits and reduced mortality rates, it has declined over the past few years due to societal and healthcare changes.

These include GPs increasingly work part-time and in larger practices; the increased prevalence of complex, chronic disease; and patients expecting fast access to any doctor. The authors say that these combined changes have resulted in fragmented care from different providers, organisations, and disciplines. Other limitations to ensuring higher levels of personal continuity are high GP workload levels and workforce shortages.

Dr Otto Maarsingh, associate professor and principal investigator from the Department of General Practice, Amsterdam Public Health Research Institute, said: “Combining real-life data and interviews with GPs, this study demonstrates dose-dependent associations between personal continuity and practice and patient characteristics, which provides targets to improve continuity of care.”