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

Abstract

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 healthcare have challenged the provision of personal continuity. Especially older patients experience more negative consequences from receiving discontinuous care. Aim To explore perspectives of general practitioners (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 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 own GP. To improve personal continuity, it was suggested to invest in team communication and stability (e.g., by efficient use of the EHR) and retaining availability and accessibility of the own GP (e.g., by delegating tasks). Barriers and facilitators were perceived on individual (e.g., GPs' involvement in tasks), organisation (e.g., staff shortages) and societal level (e.g., 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.