Improving access and continuity in general practice

The report describes our key findings on the impact of improved access upon continuity of care, and provides a series of recommendations for commissioners and policy-makers.

As the Improving Access to General Practice programme rolls out across England, we were commissioned to investigate the impact of improved access upon continuity of care.

This report summarises our key findings and provides a series of recommendations for commissioners and policy-makers. It sets out the evidence on continuity of care, its impact on clinical outcomes and wider health services, its importance to patients and GPs, and the relationship between improved access initiatives and continuity of care within general practice. The report aims to help providers, commissioners and policy-makers maximise the opportunities to improve continuity provided by the additional investment in primary care to support improved access. It examines how to achieve the optimal balance between these two dimensions of care when redesigning services for local populations.

We set out to address four key questions:

  • What is the evidence that continuity within general practice benefits patients, or is important to health professionals?
  • Which primary care patients are more likely to want continuity of care, and how likely are they to report receiving it?
  • How might policy initiatives to improve access affect continuity of care, and to what extent is there evidence of this?
  • What factors might best support continuity of care in the context of improved access?

The study combined:

  • a rapid literature review
  • interviews with nine providers, one commissioner of services, and site visits to two services that are seeking to combine access and continuity
  • analysis of data from the GP Patient Survey
  • two expert meetings involving clinicians, managers, academics and policy-makers.

We find there is a large body of evidence to demonstrate that continuity of care delivers significant benefits to patients and staff. There is, as yet, little evidence to help us understand the impact that improved access has had on continuity of care, or the precise inter-relationship between continuity and access. However, as we show, there are a considerable number of strategies that can be adopted to promote continuity of care, while improving access.

The methods are described in more detail – along with an in-depth discussion of the findings and a full set of references – in the accompanying Evidence review.

Suggested citation

Palmer W, Hemmings N, Rosen R, Keeble E, Williams S and Imison C (2018), Improving access and continuity in general practice. Nuffield Trust.