Development of a novel GP continuity measurement for practices without personal lists

Background It is widely recognised that continuity of GP care should be improved. This requires a continuity measure, applicable in all practices. Previous measures have limitations. Aim To develop an improved measure of continuity and compare its performance with established measures. Design and Setting One-year pilot in two general practices using audit data. Method The modified SLICC (mSLICC) was developed, calculated monthly and compared with the St Leonard's Index of Continuity of Care (SLICC), the 1-year Bice-Boxerman (BB) and Usual Provider of Care Index (UPC). Proportions of patients and appointments included were calculated with patients grouped by age, 3-year appointment numbers and frailty categories. Results In the two practices, the mSLICC included 19,840 out of 29,127 (68.1%) appointments and a mean of 65.2% (SD 6.4%) of patients with appointments. The UPC/BB included 21032 (72.2%) appointments and 4096 (41.2%) of 9924 patients with appointments. In practice A the mSLICC was 52.0%, SLICC 57.1%, mean UPC 0.63 (95% CI 0.62 to 0.64), and mean BB 0.41 (95% CI 0.40 to 0.43). In Practice B the mSLICC was 25.7%, SLICC 25.1%, mean UPC 0.50 (95% CI 0.49 to 0.51), and mean BB 0.23 (95% CI 0.22 to 0.25). The mSLICC correlated with the SLICC [(r)=0.98, p<0.001]. Conclusion The mSLICC is a new monthly measure of continuity. It has fewer limitations than the BB and UPC and does not require a named GP. With sufficient IT resource, the mSLICC could be used by practices without personal lists to measure continuity of care.