Development of a novel GP continuity measurement for practices without personal lists: a two-practice pilot of the modified SLICC.

Abstract (English)

BACKGROUND: It is widely recognised that continuity of GP care should be improved. This requires a continuity measure that is applicable to all practices. Previous measures have limitations. AIM: To develop an improved measure of continuity of care and compare its performance with established measures. DESIGN AND SETTING: Audit data were used to conduct a 1-year pilot of the measure in two suburban general practices in Devon, England. METHOD: The modified St Leonard's Index of Continuity of Care (mSLICC) was developed; scores were calculated monthly, and compared with those generated using the St Leonard's Index of Continuity of Care (SLICC), the 1-year Bice-Boxerman Continuity of Care (BB), and Usual Provider of Care (UPC) indices. Proportions of patients and appointments included were calculated, with patients grouped by age, sex, 3-year appointment numbers, and frailty categories. RESULTS: In the two practices, the mSLICC included 19 840 of 29 127 (68.1%) appointments and a mean of 65.2% (standard deviation [SD] 6.4%) of patients with appointments. The UPC and BB included 21 032 (72.2%) appointments and 4096 (41.3%) of 9924 patients with appointments. In practice A, the mSLICC score was 52.0%, the SLICC score was 57.1%, the mean UPC score was 0.63 (95% confidence interval [CI] = 0.62 to 0.64), and the mean BB score was 0.41 (95% CI = 0.40 to 0.43). In practice B, the mSLICC score was 25.9%, the SLICC score was 25.3%, the mean UPC score was 0.50 (95% CI = 0.49 to 0.51), and the mean BB score was 0.23 (95% CI = 0.22 to 0.25). The mSLICC correlated with the SLICC (<i>r</i> = 0.98, <i>P</i><0.001). CONCLUSION: The mSLICC is a new monthly measure of continuity. It has fewer limitations than the BB and UPC, and does not require a named GP. With sufficient IT resources, the mSLICC could be used to measure continuity of care in practices that do not use personal lists.