How much personal care in four group practices?
OBJECTIVE
To establish the degree of continuity of care in general practice.


METHODS
Retrospective study of the records of all eligible patients attending the surgery at randomly selected sessions.


METHODS
Four large group practices in the Southampton Health District, one of which operated a strict system of personal lists.


METHODS
776 Patients who had been registered for at least two years and had consulted at least 12 times over six years or less.


METHODS
Continuity score for each patient calculated from the number of consultations (out of the past 12) with his or her usual doctor. Number of the times the patients had consulted the doctor with whom they were registered.


RESULTS
In the practice with personal lists a mean of 10 of the 12 consultations had been with the same doctor (83% of consultations), but in the three practices with combined lists the means were 5.9 (49%), 6.2 (52%), and 6.9 (58%). Continuity was associated with increased age and with the recording of a major problem. In the practices with combined lists 63 of 72 children consulted at least five different doctors. Only 140 of 489 patients currently in the practice who were identified as being registered with a doctor had most usually consulted that doctor in the practices with combined lists.


CONCLUSIONS
Personal continuity of care may be fairly low in group practice, especially for younger and healthier patients registered at practices with combined lists. These findings support the Department of Health's recent decision to make "target payments" (for cervical smears and childhood immunisations) to groups rather than to individual principals but pose a question for the future of individual clinical responsibility.
Freeman
G K
GK
Primary Medical Care Group, Aldermoor Health Centre, Southampton.
Richards
S C
SC
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D004739:England; D005194:Family Practice / Q000706:statistics & numerical data*; D006123:Group Practice / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D010548:Personal Health Services; D010817:Physician-Patient Relations; D012189:Retrospective Studies