Continuity and locum use for acute consultations: observational study of subsequent workload.

Abstract

Background: Workload is probably the biggest challenge facing general practice and little is known about any modifiable factors. For GPs, both continuity and locum status are associated with differences in outcomes.

Aim: To determine whether practice and hospital workload after an index acute consultation depend on the type of GP consulted (locums and practice GPs with [regular] and without [non-regular] continuity, and locums).

Design and setting: An observational, cross-sectional analysis of consultation-level data from English general practices from the Clinical Practice Research Datalink from 2015 to 2017.

Method: Antibiotic prescription was used as a marker for acute consultations with regression models to calculate adjusted relative risks for emergency department consultations and admissions, outpatient referrals, and test ordering, as well as the patients' GP reconsultation interval following consultations with the three types of GP.

Results: After adjustment, consultations with antibiotic prescriptions with regular GPs with continuity were associated with fewer subsequent hospital admissions and lower emergency department use but higher outpatient referrals relative to locums and non-regular GPs. Locums ordered tests less often (relative risk [RR] -24.3%, 95% confidence interval [CI] = -27.3 to -21.2) than regular GPs whereas non-regular GPs ordered tests more often (RR 19.1%, 95% CI = = 16.4 to 21.8). Patients seeing their regular GP had on average a 9% longer (95% CI = 8 to 10) reconsultation interval than if they saw any other GP.

Conclusion: The differences in outcomes were associated more with having continuity than with GP locum status. Seeing a GP with whom the patient had continuity of care was associated with reduced workload within the practice and in hospital.