Seeing the same GP ‘improves patient health and reduces the workload for doctors’

Seeing the same GP improves patients’ health, reduces doctors’ workload and can free up millions of appointments, according to the largest study of its kind.

Primary care is under enormous pressure, with patients struggling to book consultations, GPs quitting or retiring early, and financial pressure forcing some practices to close. Waiting times of four weeks reached a record high in 2023, with 17.6 million appointments taking place within at least 28 days of being booked in England last year.

Research has previously suggested that there may be benefits to seeing the same GP. But the studies were usually small or covered a short period of time. Now researchers from the University of Cambridge and Insead business school have analyzed data from ten million consultations over more than a decade in the most authoritative study on the subject to date.

They found that if all primary care practices moved to a model where patients saw the same doctor at every visit, it would significantly reduce doctors’ workload while improving patient health. Multiple benefits emerged when patients had a long-term relationship with their doctor, researchers found.

When people went to the same doctor – also known as continuity of care – people waited an average of 18% longer between visits, compared to patients who visited different doctors.

People did not take up more GP time at each consultation and the findings were particularly strong in older patients, people with multiple chronic diseases and people with mental health conditions.

Although it will not always be possible for people to see their regular GP, researchers say the findings would translate into an estimated 5% reduction in consultations if all practices offered the level of care continuity of the top 10% of the practices. That suggests that millions of appointments could be freed up.

The researchers added: “Importantly, if patients receiving care from their regular physicians have longer intervals between consultations without the need for longer consultations, continuity of care may allow physicians to expand their patient lists without having to increase time use.”

In the study published in the journal Management Science, experts analyzed 10 million consultations in 381 practices in England over eleven years.

The study states: “A physician can be considered more productive if he improves the quality of care provided without reducing the number of patients he treats per year, or if he serves more patients without reducing the quality of care.

“In primary care, where patients often have a preferred doctor, these two dimensions are connected.

“If physicians provide high-quality care to their regular patients, they are likely to keep them healthier, which reduces demand for consultations and increases their capacity to serve more patients.”

Analysis of data from the English GP Survey by the Nuffield Trust showed that when asked “how often do you see or speak to your preferred GP when you would like to?”, continuity of care over time decreased.

Between 2018 and 2023, the proportion of patients who ‘always or almost always’ saw or spoke to their preferred GP fell from 26% to 16%, while those who answered ‘never or almost never’ increased from 10% to 19% .

A co-author of the study, Prof Stefan Scholtes, from Cambridge Judge Business School, said seeing the same doctor could have huge benefits.

“The impact is substantial: it could be the equivalent of increasing the GP workforce by 5%, which would significantly benefit both patients and the NHS,” he said. “Better health translates into less demand for future consultations. Prioritizing continuity of care is critical to increasing productivity.”

According to the Health Foundation and the Nuffield Trust, Britain has a major shortage of GPs, with thousands of extra doctors needed to meet demand. In the US, the Association of American Medical Colleges estimates a shortage of as many as 55,200 primary care physicians by 2033.

“Getting it right the first time” would reduce the future workload of GPs by “preventing repeat visits”, Prof Scholtes added.

For the study, researchers used anonymized data from the Clinical Practice Research Datalink, consisting of more than ten million GP visits between January 1, 2007 and December 31, 2017. The study was limited to patients who had had at least three consultations in the past two years.

Dr. Harshita Kajaria-Montag, lead author of the new study and now at Indiana University’s Kelley School of Business in the US, said: “The benefits of continuity of care are clear from a relationship perspective.

“If you are a patient with complex health needs, you don’t want to have to explain your entire health history at every appointment. If you have a regular doctor who is familiar with your history, it is a much more efficient use of time, for doctor and patient.”

Dr. Victoria Tzortziou-Brown, vice-chairman of the Royal College of GPs, said continuity of care is “highly valued by both GPs and patients”, adding: “Studies such as this are very important in informing future policy and practice .

“Currently, the intense workload and staffing pressures that GPs face – as well as political agendas that prioritize rapid access to GP services above all – significantly limit the level of continuity we can provide.”