Delivering relational continuity of care in UK general practice: a scoping review

Background: Relational continuity of care (patients seeing the same GP) is associated with better outcomes for patients, but it has been declining in general practice in the UK.

Aim: To understand what interventions have been tried to improve relational continuity of care in general practice in the UK.

Design & setting: Scoping review

Method: An electronic search of MEDLINE, Embase and Scopus from 2002 to the present day was undertaken. Sources of grey literature were also searched. Studies that detailed service-level methods of achieving relational continuity of care with a GP in the UK were eligible for inclusion. Interventions were described narratively in relation to the elements listed in the Template for Intervention Description and Replication (TIDieR). A logic model describing the rationale behind interventions was constructed.

Results: 17 unique interventions were identified. The interventions used a wide variety of strategies to try to improve relational continuity. This included personal lists, amended booking processes, regular reviews, digital technology, facilitated follow ups, altered appointment times, and use of acute hubs. 12 of the interventions targeted specific patient groups for increased continuity whilst others focused on increasing continuity for all patients. Changes in continuity levels were measured inconsistently using several different methods.

Conclusion: Several different strategies have been used in UK general practices in an attempt to improve relational continuity of care. Whilst there is a similar underlying logic to these interventions, their scope, aims and methods vary considerably. Furthermore, due to a weak evidence base, comparing their efficacy remains challenging.