Quantifying, Understanding and Enhancing Relational Continuity
of Care

What is Relational Continuity of Care?

Male doctor in a blue shirt with a stethoscope

Relational continuity of care (RCC) describes a relationship where patients see the same doctor over time. Research shows that both patients and General Practitioners value RCC and the evidence also suggests that it has benefits for patients because they request fewer follow up appointments and experience better health. Although current NHS policy aims to maintain continuity for patients with long-term conditions such as diabetes, RCC has been declining for at least a decade. This decline may be because general practices are getting bigger, with more General Practitioners in each practice. The decline may also be linked to more doctors working part-time or moving from one practice to another. It may also be due to a focus on improving patient access, rather than continuity.

General practices in the UK vary widely in the numbers of patients they see and the services they offer. To learn more about how these differences between practices affect RCC the QUERCC study will collect a wide range of data using different methods. The overall aim is to provide guidance to help General Practitioners to measure and improve relational continuity of care for their patients.

The study has five steps

In the first phase we will hold two workshops to develop a shared understanding of what RCC means and how we can best measure it. The workshops will bring together three groups of participants: patients, clinicians (doctors, nurses, occupational therapists, physiotherapists) and researchers interested in RCC. We will use the findings from the workshops to inform the next steps of our study. 

Second, we will analyse data from a large selection of general practices to look at how staff turnover, part-time working, practice size and funding per patient affect RCC in different general practices. From this work we will also see which practices have unusually high RCC.

Third, we will conduct case studies in a selection of general practices with unusually high RCC. The case studies will identify how these general practices achieve their high RCC and which things helped or hindered them in doing so. We will also find out if there are any drawbacks to achieving high RCC.

Patients who have higher RCC seems to have better health, fewer hospital admissions and may visit their GP less frequently. Using data from a large selection of general practices, we will estimate the costs of providing RCC, the cost-savings linked to higher RCC and the health benefits of providing higher RCC.  The economic analysis will show whether providing higher RCC is a more efficient way to offer care. It will also show if RCC is more important for some patient groups, such as those who are older, from more deprived areas or who have long-term health conditions.

Near the end of the study, we will hold two workshops to develop practical guidance to help General Practices improve continuity of care. The workshops will include patients, clinicians and researchers.  By including members of organisations such as the Royal College of General Practitioners (RCGP) and patient representatives we will ensure our guidance is relevant and practical for General Practitioners and for patients. 

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