Continuity of Care

Continuity of care at Tudor Lodge Surgery

Many of you are aware that Dr Jack Haigh has now joined us as a permanent Salaried GP. Dr Haigh will be here 3 days a week and we have just done some reallocation of patients so they are fairly spread in terms of numbers across the whole team. This was an automated process, not done based on individuals.

It is essential that we spread the patient numbers equitably, based on the number of days (or ‘sessions’) that GPs work. This keeps access good and is also the only way we have of making sure that GPs get a fair and proportionate amount of the clinical administration work that goes on in the background, for example pathology results such as blood samples and actioning of clinical letters from hospital. It is therefore a way to keep the work fairly allocated and supports workload management for GPs. Operationally, it is extremely helpful to have individual lists and we have done this since January 2019. However, the main reason for us doing this is that it improves patient outcomes. There is a growing body of research to support this. Improved patient outcomes means things like avoiding unnecessary hospital admissions, there is even some evidence that it reduces mortality. Having a clinician who knows you is literally good for your health!

We participated in a large study back in 2019 with The Health Foundation (‘Continuity by Design’) and were the practice that saw the greatest improvement in continuity as a result. Read the Continuity by Design evaluation report (PDF)

We have also taken part in the more recent Continuity Study ‘Accessing Continuity’ which is currently still running: Accessing Continuity (2025 - ongoing) — Primary care Academic CollaboraTive (PACT).

We were delighted to run the continuity tool and have confirmation that we still have extremely high levels of continuity since we first started to prioritise this in January 2019.

But how does this fit with the multidisciplinary team in the surgery?

What we see now is that when patients have appointments with other team members at the surgery it is because of their specialisms and the enhanced skills they have. This enables the GPs to specialise in general practice. Sounds odd but being a GP is all about having enormous breadth of experience alongside a bit of depth, but most depth is delivered by specialists in specific areas. Having other specialists also enables the GPs to have the time to spend with their patients to manage the complexity of what is known as ‘multi-morbidity’, in other words, people having a lot of different conditions and how to manage this holistically. The other specialists we have – in no particular order:

• Respiratory nurse (Caroline Bazell) – alongside being our lead nurse, Caroline has expertise in respiratory conditions, especially COPD and supports our patients who have frequent exacerbations to try to keep them as well as possible.
• Mental health nurse (Sarah Matthews) – who can spend a little longer with patients who are seeking support with their mental health.
• Diabetic specialist nurse (Rahab Hashim) – who having worked at the hospital is now supporting patients in primary care with the more complex sides of diabetes. We also have other long term condition nurses who undertake annual reviews with patients and are well qualified to do so.
• HRT/Menopause (Sharon Hartmann) – has a higher level of qualification in this area than others and can therefore offer more specialist support and advice to the more complex elements of HRT/Menopause.
• Care Home specialist nurse (Jane Base) – Jane has had such an extensive career working with (and in) care homes, her knowledge and skills to support those with high levels of frailty and complexity is superb.
• Learning Disabilities (Hayley Johnson) – Hayley is a learning disabilities specialist nurse with fantastic expertise in this important area. Hayley sees those with learning disabilities for their annual health checks and also supports a number of care homes with mental health and/or learning disabilities residents.

The list above is not exhaustive!

It would be true to say that if you want to talk about a specialist area, for example COPD or diabetes, then a GP is not the best person to speak with. It is a whole team that is needed to support patients and provide the best possible care. We would like to think that the only things that interrupt continuity are specialist input required or holiday!

Can I have a preference between a male or female GP?

The answer is that it depends. We now have 3 male GPs having had many years of being predominantly female GP based. We do need to have an equitable spread of patients. Patients have a tendency to prefer female GPs. Perhaps this is because female patients worry about having gynaecological problems and not wanting to see a male GP. In these cases there are two options: firstly we can book you with a female GP for that problem and then pass you back to your original usual GP, or we can offer you a chaperone (actually we can offer you this for any appointment). What we would say is please only request a different GP if you have a significant reason to do so. Also bear in mind that in so many cases, even if you are referred to a hospital consultant, you would have no choice in the gender of the clinician.