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Access & Continuity

Access & Continuity. Londonwide LMCs 12 th February 2014 George Freeman Emeritus Professor of General Practice Imperial College London. relationship continuity. continuity is about care of individuals over time - three types Relationship (or interpersonal) Management (or coordination)

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Access & Continuity

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  1. Access & Continuity Londonwide LMCs 12th February 2014 George FreemanEmeritus Professor of General PracticeImperial College London

  2. relationship continuity continuity is about care of individuals over time - three types • Relationship (or interpersonal) • Management (or coordination) • Informational Everyone wants management & informational continuity but GPs face two ways on relational continuity Access & Continuity - George Freeman for Londonwide LMCs

  3. ambivalence about relationship continuity • it’s a cornerstone of general practice but • we haven’t time for a personal service these days - especially given current access pressures Access & Continuity - George Freeman for Londonwide LMCs

  4. benefits of relationship continuity • satisfaction for patients and staff • most patients want it – more than they can get • especially in London • lower costs • admissions (emergency & elective) • tests • referrals • better problem recognition • easier care of people with multimorbidity Access & Continuity - George Freeman for Londonwide LMCs

  5. why continuity is essential for generalists seeing the same doctor • promotes mutual trust • encourages a therapeutic relationship • fills in generalist picture with • context • history & knowledge – tacit as well as recorded • personal values and priorities • compensates for less specialist expertise Access & Continuity - George Freeman for Londonwide LMCs

  6. multi-morbidity care enhanced by • shared experience of identifying and coping with problems over time • familiarity with relevant factors for prioritising care options for example • back in 1980 Howie found that if mothers were on psychotropic drugs then their children were more likely to get antibiotics for URTI ! Access & Continuity - George Freeman for Londonwide LMCs

  7. multimorbidity • increasingly prevalent • more prevalent with advancing age but most multimorbidity seen in under 65s • associated with deprivation Access & Continuity - George Freeman for Londonwide LMCs

  8. access & continuity -1 • patients want both but it’s partly a trade-off! • actually most patients understand this • seeing the same doctor is prioritised for serious and chronic conditions • by all age groups • and patients will wait several days to see the right doctor • any clinician will do for short-term or minor problems Access & Continuity - George Freeman for Londonwide LMCs

  9. access & continuity - 2 • not all a trade-off – better continuity can both reduce demand and make it more appropriate • practices can improve continuity to manage access pressures • reduces repeat consultations • patients happier to wait a few days Access & Continuity - George Freeman for Londonwide LMCs

  10. how to improve relationship continuity • receptionists & appointments • prioritising and training • telephone and e-consultation • best for follow-up – and with known doctor • in the consulting room • set an example • smaller teams for large practices • too much choice is confusing Access & Continuity - George Freeman for Londonwide LMCs

  11. discussion questions what are the issues for continuity in your practice? how to address these? for example • personal availability and longer opening hours? • part-timers & continuity? • continuity and commissioning? • QOF and availability? Access & Continuity - George Freeman for Londonwide LMCs

  12. assess your own continuity! How much do patients actually see the same doctor in your practice? - for a simple guide on how to audit your own performance from your records system, we suggest the following link to the work of colleagues in the University of Bristol http://www.bristol.ac.uk/primaryhealthcare/resources/continuityaudit/ Access & Continuity - George Freeman for Londonwide LMCs

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