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Editor’s Notes #002: The continuity continuum

Headshot of Euan LawsonEuan Lawson is editor of the BJGP. He is on Twitter @euan_lawson and DMs are open if you want to get in touch.

The profile of continuity is rising. In the February issue we published two important papers about continuity. The first one was a large study from Norway and showed impressive reductions in emergency admissions and deaths associated with having a named GP. The second was home grown from the Exeter group, where continuity research and advocacy has long found a home, and showed associations between continuity and reduced risk of delirium, incontinence and emergency admission.

Yet, I also wrote in the January Briefing that when it came to continuity we are “losing the battle”. This is not because GPs and staff and patients don’t value continuity. It’s simply a function of the pressure on the system. In the February Briefing I sounded a note of caution about our desire for more continuity. We need more high quality research like these papers to cut through the noise.

On 25 Jan 2022, Jeremy Hunt put forward this evidence from these BJGP papers to the Secretary of State for Heath, Sajid Javid.

Some will find it a little hard to swallow that our standard bearer here is Jeremy Hunt but one has to give credit for putting forward the right message now.

The danger is that the government listens but, as is their wont, starts to look for quick fixes. Hunt himself introduced a named GP scheme in 2014 but we know, as Peter Tammes and colleagues found, that continuity has been declining. So we have very few easy solutions. Naming a GP as the person responsible does nothing to provide the time and capacity to allow it to happen. It would be worryingly easy for top-down diktats to emerge — we only have to squint briefly at squalid access targets to become nauseated at the prospect.

There is scope, while the long work is done, to prioritise continuity in the right groups. At one end of the spectrum, there are people without chronic conditions who would appear to not need continuity as a priority. At the other end, are those, like people with dementia, where it now seems essential. Yet, there is significant complexity here and people can develop chronic conditions at any point and assumptions on benefits are fraught. Any kind of mixed model that provides continuity on a selective base, out of sheer necessity, will need careful assessment.

‘Format-light’ is now live

We have, as promised last time, now implemented the policy of ‘format-light’. We have removed some of the specific formatting requirements that we ask for when research articles are initially submitted via the ScholarOne system. More details here: https://bjgp.org/authors/writing-for-bjgp-research#Format-light%20submissions

Feedback so far has been encouraging:

 

February 2022 Editor’s Briefing links

Here are the relevant links that were mentioned in the Briefing.

“The Sandvik study on continuity in this month’s issue feels right to GPs and fits with existing evidence.” This is the paper: Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway and it can found at https://doi.org/10.3399/BJGP.2021.0340

“As GP Dr Phil Whitaker wrote in the New Statesman…” This was an article from the 08 December 2021 New Statesman. In it, Phil wrote about the Sandvik paper, his own experience, and he also interviewed Professor Sir Denis Pereira Gray.

.”..as the legendary Sergeant Phil Esterhaus from the 80s cop show Hill Street Blues used to exhort: Let’s be careful out there.”  I am barely old enough to know Hill Street Blues very well but catching up with it on All4 was a lockdown pleasure and the early seasons have worn well.

YouTube player

“The analysis of doctor empathy on patient outcomes by Surchat…” came from Impact of physician empathy on patient outcomes: a gender analysis and can be found at: https://doi.org/10.3399/BJGP.2021.0193

“Grigoroglou et al’s paper found that locum use didn’t increase between 2017 and 2020 in England.” came from Locum doctor use in English general practice: analysis of routinely collected workforce data 2017–2020 and can be found at: https://doi.org/10.3399/BJGP.2021.0311

“Evans et al explored how an emergency risk prediction tool worked in Wales, or more accurately didn’t work as intended.” came from Implementing emergency admission risk prediction in general practice: a qualitative study and can be found at: https://doi.org/10.3399/BJGP.2021.0146

 

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