Patient perceptions of relational continuity in England: insights from two cross-sectional surveys

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Abstract
Background: Declining continuity of care in England could disproportionately affect some patient groups. Aim: To examine patients’ perceptions of continuity of primary care, identify factors associated with continuity, and measure changes in continuity of care for different patient groups, following primary care network (PCN) implementations. Design & setting: Cross-sectional surveys were undertaken of patients from three groups (older adults with polypharmacy, patients with mild or moderate anxiety or depression, and working-age adults [18–45 years]), attending 19 practices in five PCNs in England, at two timepoints (November 2021–April 2022 and November 2022–April 2023). Method: Relational continuity was measured using the Nijmegen Continuity Questionnaire (NCQ) score. Differences between patient groups and two timepoints were tested using multiple linear regression. Results: Survey response rates were n = 362/1547 (23%) and n = 350/1528 (23%). Adults with polypharmacy experienced significantly better continuity than adults with anxiety or depression and younger working-age adults after adjusting for PCN, practice, and population-level characteristics ( P < 0.05). Those who always or sometimes saw their preferred GP experienced significantly better continuity than those who never did ( P < 0.01). PCNs with pre-existing inter-practice collaborations were not associated with differences in relational continuity. Conclusion: We found differences in experienced continuity of care between patient groups. Relational continuity depends on seeing a preferred GP, not a non-preferred GP or other healthcare professional (HCP). Better continuity was associated with larger practice networks.

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