Understanding continuity of care in primary care extended access hubs
When patients experience care that is joined up and consistent, it is known as ‘continuity of care’. This has been linked to better outcomes. Traditionally, continuity has been viewed as patients seeing the same doctor. However, other factors are now viewed to be important, including staff having access to the necessary information about each patient, and services working together. Existing research into continuity of care has not examined how new ways of working in primary care, such as extended access services, have affected patients’ experience of continuity and how this may affect the care they receive. In order to fulfil a government policy of allowing patients to see a GP from 8am till 8pm and at the weekends, patients in many locations are being offered appointments away from their own practice in “extended access hubs”. We do not know the impact of this upon a patient’s experience of continuity.
There are two main components to the study. An quantitative analysis of data from the GP patient survey will help us ascertain how the introduction of extended access has affected levels of continuity and which groups of patients are more likely to use the service. A two site case study using focused ethnography, patient interviews and case note review will enable us to understand how the mechanisms of continuity work to produce outcomes for patients who attend extended access hubs.
1. Is there a relationship between patients’ use of extended access appointments and their experience of continuity of care?
2. How do extended access hubs deliver continuity of care?
3. How do the differing types of continuity (relational, informational and management) interact to produce outcomes in extended access hubs?
4. How might extended access hubs change their approach to service delivery to support beneficial types of continuity?