Improving personal continuity in general practice: a focus group study.

Background: Personal continuity is an important dimension of continuity of care in general practice and is associated with many benefits including a higher quality of GP care and lower mortality rate. Over time, changes in society and health care have challenged the provision of personal continuity. Older patients in particular experience more negative consequences from receiving discontinuous care.

Aim: To explore the perspectives of GPs, older patients, practice nurses, and assistants on improving personal continuity in general practice, and to identify barriers and facilitators that affect this improvement process.

Design and setting: A qualitative study using focus groups was conducted from May to August 2019.

Method: We organised four focus groups: two with GPs (n = 17), one with patients (n = 7), and one with practice assistants (n = 4) and practice nurses (n = 2). Focus groups were analysed using reflexive thematic analysis.

Results: Personal continuity was viewed as being provided by the entire general practice team and not just by the patient's own GP. It was suggested that investing in team communication and stability (for example, by efficient use of the electronic health records) and retaining the availability and accessibility of the patient's own GP for patient care, especially for frail older persons, (for example, by delegating tasks) could improve personal continuity. Barriers and facilitators were perceived at the individual (for example, GPs' involvement in tasks), organisation (for example, staff shortages), and societal level (for example, payment system).

Conclusion: As general practice moves towards a more team-based approach to ensure personal continuity, efforts to improve personal continuity should focus on supporting team-based provision of continuous care.