̽��ֱ�� of Cambridge - general practice

Having a ‘regular doctor’ can significantly reduce GP workload, study finds

sc604 — Fri, 23 Feb 2024 01:11:40 +0000

In one of the largest studies of its kind, researchers from the ̽��ֱ�� of Cambridge and INSEAD analysed data from more than 10 million consultations in 381 English primary care practices over a period of 11 years.

̽��ֱ��results, reported in the journal Management Science, suggest that a long-term relationship between a patient and their doctor could both improve patient health and reduce workload for GPs.

̽��ֱ��researchers found that when patients were able to see their regular doctor for a consultation – a model known as continuity of care – they waited on average 18% longer between visits, compared to patients who saw a different doctor. ̽��ֱ��productivity benefit of continuity of care was larger for older patients, those with multiple chronic conditions, and individuals with mental health conditions.

Although it will not always be possible for a patient to see their regular GP, this productivity differential would translate to an estimated 5% reduction in consultations if all practices in England were providing the level of care continuity of the best 10% of practices.

Primary care in the UK is under enormous strain: patients struggle to get appointments, GPs are retiring early, and financial pressures are causing some practices to close. According to the Health Foundation and the Nuffield Trust, there is a significant shortfall of GPs in England, with a projected 15% increase required in the workforce. ̽��ֱ��problem is not limited to UK, however: the Association of American Medical Colleges estimates a shortfall of between 21,400 and 55,200 primary care physicians in the US by 2033.

“Productivity is a huge problem across all the whole of the UK – we wanted to see how that’s been playing out in GP practices,” said Dr Harshita Kajaria-Montag, the study’s lead author, who is now based at the Kelley School of Business at Indiana ̽��ֱ��. “Does the rapid access model make GPs more productive?”

“You can measure the productivity of GP surgeries in two ways: how many patients can you see in a day, or how much health can you provide in a day for those patients,” said co-author Professor Stefan Scholtes from Cambridge Judge Business School. “Some GP surgeries are industrialised in their approach: each patient will get seven or ten minutes before the GP has to move on to the next one.”

At English GP practices, roughly half of all appointments are with a patient’s regular doctor, but this number has been steadily declining over the past decade as GP practices come under increasing strain.

̽��ֱ��researchers used an anonymised dataset from the UK Clinical Practice Research Datalink, consisting of more than 10 million GP visits between 1 January 2007 and 31 December 2017. Using statistical models to account for confounding and selection bias, and restricting the sample to consultations with patients who had at least three consultations over the past two years, the researchers found that the time to a patient’s next visit is substantially longer when the patient sees the doctor they have seen most frequently over the past two years, while there is no operationally meaningful difference in consultation duration.

“ ̽��ֱ��impact is substantial: it could be the equivalent of increasing the GP workforce by five percent, which would significantly benefit both patients and the NHS,” said Scholtes. “Better health translates into less demand for future consultations. Prioritising continuity of care is crucial in enhancing productivity.”

“ ̽��ֱ��benefits of continuity of care are obvious from a relationship point of view,” said Kajaria-Montag. “If you’re a patient with complex health needs, you don’t want to have to explain your whole health history at every appointment. If you have a regular doctor who’s familiar with your history, it’s a far more efficient use of time, for doctor and patient.”

“A regular doctor may have a larger incentive to take more time to treat her regular patients thoroughly than a transactional provider,” said Scholtes. “Getting it right the first time will reduce her future workload by preventing revisits, which would likely be her responsibility, while a transactional provider is less likely to see the patient for her next visit.”

̽��ֱ��researchers emphasise that continuity of care does not only have the known benefits of better patient outcomes, better patient and GP experience, and reduced secondary care use, but also provides a surprisingly large productivity benefit for the GP practices themselves.

Reference:
Harshita Kajaria-Montag, Michael Freeman, Stefan Scholtes. ‘Continuity of Care Increases Physician Productivity in Primary Care.’ Management Science (2024). DOI: 10.1287/mnsc.2021.02015

If all GP practices moved to a model where patients saw the same doctor at each visit, it could significantly reduce doctor workload while improving patient health, a study suggests.

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Doctor examining a patient

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Graduate, get a job … make a difference #7

ta385 — Tue, 19 Sep 2017 10:00:00 +0000

Gwilym Thomas (Trinity Hall), MB, Medicine (2015)

I graduated from Cambridge’s Medicine course in 2015 and I’m now working as a second year GP trainee, having already completed two years of post-qualification foundation training.

I’m currently based in A&E at the West Suffolk Hospital where my focus is on providing timely care and deciding whether someone can then return home or needs to be admitted for on-going treatment.

Junior doctors like me rotate jobs every four to six months so there is constant variety. Prior to A&E, I was working on a Care of the Elderly ward. I hope to be a GP within two to three years and during that time continue my involvement with Primary Care research.

My Motivation

I’m inspired by the positive impact I can make on the lives of patients and their families as part of a multidisciplinary team. I get particular satisfaction from taking a holistic approach, one of the tenets of GP training.

When I started at Cambridge, General Practice was near the bottom of my list of career options. I felt it might be repetitive and lacking in intellectual rigour, but actual experience completely changed my mind. In primary care I had such enthusiastic GP tutors and saw how embracing not just the biological but also psychological and social aspects of a patient’s problem could lead to better outcomes.

On the flipside, the biggest challenges I face are the long hours, difficult decisions and emotional challenges inherent in the job, alongside the wider issues in the NHS and social care.

What Cambridge did for me

̽��ֱ��Cambridge medical course is founded on core science which is later developed during clinical training, which seemed to match my learning style. In unfamiliar situations I can often problem-solve from first principles due to this sound scientific basis. It has also made me familiar with critically appraising evidence and that helps my clinical decision-making.

I discovered the world of primary care research, almost by accident, through Student Selected Components (SSC). Professor Jonathan Mant was my supervisor on my first Primary Care related SSC, which took me to the interface between stroke rehab in the hospital and community. Later, he encouraged me to submit an abstract to the Society for Academic Primary Care (SAPC) regional conference, and presenting there made me very enthusiastic about academic Primary Care. Professor Martin Roland, Dr Charlotte Paddison and Dr Katie Saunders supervised me on my second SSC in the Primary Care Unit. They gave me a lot of support to present again at SAPC, locally and nationally, and to publish the paper with which I won a Royal College of General Practitioners research prize in 2016.

My time at Cambridge proved so many of my preconceptions about primary care wrong. I soon learnt that GPs must use their clinical and diagnostic skills to make diagnoses, or deal with uncertainty, with fewer resources than available in hospital. I found there are also opportunities to develop specialist interests. My clinical placements were in various specialties and locations which helped me learn to integrate rapidly into a team and give me an insight into my eventual career plans. I also received really effective teaching in communication skills, which I continue to develop as a GP trainee.

During my 4th and 5th years, I spent several weeks with the practice team at Nene Valley Medical Practice in Peterborough, and that longitudinal placement really inspired and helped me to become a GP. During my elective in Scotland I received a lot of support and great advice from the anaesthetic department at Lorn and Islands Hospital in Oban. ̽��ֱ��short time I spent at the small, two-GP, Easdale Medical Practice, on the Isle of Seil also inspired me a great deal. Since graduating, the GPs at both Guildhall and Barrow Surgery in Bury St Edmunds, and the Grove Surgery in Thetford have been really supportive, friendly and knowledgeable. West Suffolk Hospital has been a good place to train as a junior doctor.

Applying to Cambridge

I grew up in Shepshed, a village in Leicestershire, and went to school in Loughborough. I was fortunate in having university-educated parents and in attending a school where Oxbridge applications were encouraged. But during my teenage years I had a lot of time out of school due to illness – I was diagnosed with Crohn's disease. I had to restart my GCSE year and, prior to returning, my head teacher advised me that either medicine or Oxbridge might be a realistic goal but, concerned for my health and welfare, they told me it might be best not to aim for both. I doubt they know how much that drove me to prove them wrong!

Crohn’s made the rest of school and the start of university a battle but I was open on my application about my illness and the potential for things to go wrong. I spoke to the ̽��ֱ��’s Disability Resource Centre team at an open day and my College also made me aware of all the support available if I needed it, which fortunately I rarely did. I did, however, receive targeted financial support via a Disabled Student's Allowance which made a huge difference to my confidence when I started at Cambridge. I have been in remission for some time now but being in some situations as both a patient and relative does, I think, help me approach things more holistically as a doctor.

It is really important with a medical degree to consider the course structure. While the traditional model at Cambridge suited me, it may not match everyone’s learning style. As for choosing a college, I didn't know where to start so decided to visit a shortlist on open day. I settled on Trinity Hall, where I felt most at home, a decision I’ve never regretted.

Cambridge graduates enter a wide range of careers but making a difference tops their career wish lists. In this series, inspiring graduates from the last three years describe Cambridge, their current work and their determination to give back.

My time at Cambridge proved so many of my preconceptions about primary care wrong.

Gwilym Thomas, MB, Medicine (2015)

Find out more

For more information about studying Medicine at Cambridge.

Find out more about General Practice as a career.

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Improving access to GP surgeries could reduce burden on out-of-hours services

cjb250 — Wed, 21 May 2014 22:30:00 +0000

Out-of-hours primary care services – such as a telephone consultation followed by a home visit or attendance at an out-of-hours centre – present several disadvantages compared to in-hours services. Not only are these services more expensive to the NHS, but maintaining the high standards of care and patient experience out-of-hours is challenging. In part this is because patients using out-of-hours services will often be seen by doctors unfamiliar with their potentially complex case histories. For these reasons, modern healthcare systems aim to reduce demand for out-of-hours primary care.

In a study published in the Emergency Medicine Journal, researchers from the ̽��ֱ�� of Cambridge and the ̽��ֱ�� of Exeter Medical School analysed data from almost 570,000 respondents to the 2011/2012 English General Practice Patient Survey to see why people used out-of-hours services and to identify ways of reducing this burden.

̽��ֱ��researchers found that a proportion of patients faced a number of potential barriers to accessing GP surgeries including an ability to get through to the surgery on the telephone or to get an appointment, urgent or otherwise, as well as inconvenient opening hours. ̽��ֱ��patients who experience these difficulties have a higher chance of resorting to the use of out-of-hours primary care services.

7.5% of respondents reported using out-of-hours services in the previous six months though not all of these were due to difficulties in accessing regular GP services. ̽��ֱ��researchers estimate that optimising access to in-hours services would reduce this to 6.7%, a relative reduction of 11%.

Dr Yin Zhou from the Cambridge Centre for Health Services Research says: “ ̽��ֱ��use of out-of-hours services is not ideal for the patient and can be costly to the NHS. If we’re to reduce the burden on the NHS and improve patient care, then we need to make improvements in providing access to GP surgeries.”

Contrary to expectations, the researchers found that the association between out-of-hours use and the convenience of surgery opening hours was stronger amongst people in part-time than those in full-time work or education. In other words, even when opening hours suited people in part-time work, they were more likely to attend out-of-hours services than those in full-time work or education.

Professor Martin Roland, Director of the Centre, adds: “Our research suggests that improving access to regular services is not as straightforward as just extending opening hours, which current Government policies favour. Even those in part-time work can struggle to get an appointment, so offering greater availability during regular surgery hours would help reduce use of out-of-hours services.”

̽��ֱ��study was funded by the East of England Multi-Professional Deanery, the Department of Health and the National Institute of Health Research.

Poor access to GP surgeries could be driving patients to use out-of-hours services and putting an extra burden on the NHS, according to researchers at the Cambridge Centre for Health Services Research. In research published today, they say that improving access could lead to an 11% reduction in the use of out-of-hours primary care services.

Improving access to regular services is not as straightforward as just extending opening hours, which current Government policies favour

Martin Roland

Julian Claxton Photography, Wellcome Images

GP consultation with a female patient

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