Development of a novel GP continuity measurement for practices without personal lists: a two-practice pilot of the...

It is widely recognised that continuity of GP care should be improved. This requires a continuity measure that is applicable to all practices. Previous measures have limitations.

To develop an improved measure of continuity of care and compare its performance with established measures.

Audit data were used to conduct a 1-year pilot of the measure in two suburban general practices in Devon, England.

The modified St Leonard's Index of Continuity of Care (mSLICC) was developed; scores were calculated monthly, and compared with those generated using the St Leonard's Index of Continuity of Care (SLICC), the 1-year Bice-Boxerman Continuity of Care (BB), and Usual Provider of Care (UPC) indices. Proportions of patients and appointments included were calculated, with patients grouped by age, sex, 3-year appointment numbers, and frailty categories.

In the two practices, the mSLICC included 19 840 of 29 127 (68.1%) appointments and a mean of 65.2% (standard deviation [SD] 6.4%) of patients with appointments. The UPC and BB included 21 032 (72.2%) appointments and 4096 (41.3%) of 9924 patients with appointments. In practice A, the mSLICC score was 52.0%, the SLICC score was 57.1%, the mean UPC score was 0.63 (95% confidence interval [CI] = 0.62 to 0.64), and the mean BB score was 0.41 (95% CI = 0.40 to 0.43). In practice B, the mSLICC score was 25.9%, the SLICC score was 25.3%, the mean UPC score was 0.50 (95% CI = 0.49 to 0.51), and the mean BB score was 0.23 (95% CI = 0.22 to 0.25). The mSLICC correlated with the SLICC (r = 0.98, P<0.001).

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 resources, the mSLICC could be used to measure continuity of care in practices that do not use personal lists.