Sustaining named GP continuity requires organisational change: comparative implementation analysis in Finland

Area of Science:

• Primary care research
• Health services research
• General practice

Background:

• Doctor-patient relationship continuity is a persistent challenge in public primary care.
• Workforce pressures and organizational constraints hinder continuity in Finland and globally.
• A named general practitioner (GP) model aims to improve continuity of care.

Purpose of the Study:

• To evaluate the implementation of a named GP model in two Finnish primary care units.
• To explain differences in implementation outcomes between the two units.
• To assess the impact of the named GP model on continuity of care.

Main Methods:

• A quasi-experimental before-after study design was used in two Finnish primary care units.
• Patient continuity was measured using Usual Provider of Care Index (UPC), St Leonard's Index of Continuity of Care (SLICC), and Own Patient Ratio (OPR).
• Implementation outcomes were analyzed using the RE-AIM framework and segmented Interrupted Time Series (ITS) models.

Main Results:

• The named GP model showed higher continuity in Tuira compared to Pudasjärvi across all measures.
• Tuira demonstrated high adoption (OPR 0.88) and stable, lower variation, with modest improvements in reach and effectiveness.
• Pudajärvi had weaker adoption (OPR 0.40), lower reach (SLICC 0.16), and less stable maintenance, though overall continuity improved.

Conclusions:

• The named GP model was functionally adopted in Tuira but remained largely nominal in Pudasjärvi.
• Sustained GP presence and organizational alignment are crucial for successful named GP model implementation.
• Health systems should prioritize these factors to achieve improved continuity of care.