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

Miglena N Fox; Jon M Dickson; Patrick Burch; Daniel Hind; Olivia Hawksworth

doi:10.3399/BJGPO.2024.0041

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Relational Continuity
Denis J Pereira Gray, Kate Sidaway-Lee and Philip Evans

Published on: 13 June 2024

Published on: (13 June 2024)
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Relational Continuity
Denis J Pereira Gray, Consultant/ Emeritus Professor, St Leonard's Practice/ University of Exeter
Other Contributors:
Kate Sidaway-Lee, Research Fellow

Philip Evans, Professor of Primary Care Research
Sir / Madam,

We welcome Fox et al’s scoping review of relational continuity as it studies a subject of increasing importance. However, we note some limitations in some of their methods and conclusions. Whilst we understand that scoping reviewers may choose to not include results of the studies found, this decision does limit their value.

With the caveat that we are writing without the benefit of access to the supplemental data, they present no numerical results for continuity achieved by any method so their readers cannot know how much is possible in clinical practice. Although not all reports contain numerical results, some do, and these could have been included even if comparison is not possible. They weaken the impact of the study by considering only methods and not outcomes.

Secondly, they have stated that during our Health Foundation project — Continuity Counts, 2022 — one practice targeted frequent attenders. This was not the case as all practices attempted to provide continuity to their entire registered populations and this was what was measured and reported.

Finally, based on their eligibility criteria, we are not sure why our study from 2019 (Sidaway-Lee et al) was not included. This was a peer-reviewed report featuring a UK general practice as a case study, using personal lists as a method to improve relational continuity. It reported two years’ continuity results using both the SLICC and the UPC.

References
Fox MN, Dick...
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Sir / Madam,

We welcome Fox et al’s scoping review of relational continuity as it studies a subject of increasing importance. However, we note some limitations in some of their methods and conclusions. Whilst we understand that scoping reviewers may choose to not include results of the studies found, this decision does limit their value.

With the caveat that we are writing without the benefit of access to the supplemental data, they present no numerical results for continuity achieved by any method so their readers cannot know how much is possible in clinical practice. Although not all reports contain numerical results, some do, and these could have been included even if comparison is not possible. They weaken the impact of the study by considering only methods and not outcomes.

Secondly, they have stated that during our Health Foundation project — Continuity Counts, 2022 — one practice targeted frequent attenders. This was not the case as all practices attempted to provide continuity to their entire registered populations and this was what was measured and reported.

Finally, based on their eligibility criteria, we are not sure why our study from 2019 (Sidaway-Lee et al) was not included. This was a peer-reviewed report featuring a UK general practice as a case study, using personal lists as a method to improve relational continuity. It reported two years’ continuity results using both the SLICC and the UPC.

References
Fox MN, Dickson JM, Burch P, Hind D, Hawksworth L. Delivering relational continuity of care in UK general practice: a scoping review. BJGP Open. 2024 Mar 6:BJGPO.2024.0041.
Sidaway-Lee K, Gray DP, Evans P. A method for measuring continuity of care in day-to-day general practice: a quantitative analysis of appointment data. Br J Gen Pract. 2019 May;69(682):e356-e362.
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Competing Interests: We ran the Health Foundation project mentioned in the letter and were the authors of Sidaway-Lee et al 2019.