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This article explores the decline in relationship continuity in England and the potential for learning from a European perspective. It emphasizes the value of continuity for patients and its association with better outcomes, while acknowledging the challenges in measuring continuity. The article compares the levels of continuity in England with other European countries and raises questions about how much continuity is needed and with whom. It suggests that improving continuity can have positive impacts on outcomes and productivity, but cautions against potential adverse effects and the need to consider practice populations. The article discusses the challenges faced by practices with older and less healthy patients and suggests considering non-financial incentives alongside financial incentives. It emphasizes the need for tailored policy frameworks and local initiatives to address barriers and enablers of continuity. The article also highlights the importance of integrated and patient-centered care and looks to successful approaches in European countries for inspiration. It concludes by calling for objective evaluation and collaborative research to identify effective strategies for improving continuity. [Extracted from the article]

Background: There are not enough GPs in England. Access to general practice and continuity of care are declining. Aim: To investigate whether practice characteristics are associated with life expectancy of practice populations. Design and setting: A cross-sectional ecological study of patient life expectancy from 2015–2019. Method: Selection of independent variables was based on conceptual frameworks describing general practice's influence on outcomes. Sixteen non-correlated variables were entered into multivariable weighted regression models: population characteristics (Index of Multiple Deprivation, region, % White ethnicity, and % on diabetes register); practice organisation (total NHS payments to practices expressed as payment per registered patient, full-time equivalent fully qualified GPs, GP registrars, advanced nurse practitioners, other nurses, and receptionists per 1000 patients); access (% seen on the same day); clinical performance (% aged ≥45 years with blood pressure checked, % with chronic obstructive pulmonary disease vaccinated against flu, % with diabetes in glycaemic control, and % with coronary heart disease on antiplatelet therapy); and the therapeutic relationship (% continuity). Results: Deprivation was strongly negatively associated with life expectancy. Regions outside London and White ethnicity were associated with lower life expectancy. Higher payment per patient, full-time equivalent fully qualified GPs per 1000 patients, continuity, % with chronic obstructive pulmonary disease having the flu vaccination, and % with diabetes with glycaemic control were associated with higher life expectancy; the % being seen on the same day was associated with higher life expectancy in males only. The variable aged ≥45 years with blood pressure checked was a negative predictor in females. Conclusion: The number of GPs, continuity of care, and access in England are declining, and it is worrying that these features of general practice were positively associated with life expectancy. [ABSTRACT FROM AUTHOR]

Background Identifying features associated with atrial fibrillation (AF) documentation could inform screening. This study used published data to describe differences in documented and estimated AF prevalence in general practices, and explored predictors of variations in AF prevalence. Methods Cross-sectional study of 7318 general practices in England. Descriptive and inferential statistics were undertaken. Multiple linear regression was used to model the difference between estimated AF and documented AF, adjusted for population, practice and practice performance variables. Results Documented AF prevalence was lower than estimated (− 0.55% 95% confidence intervals, −1.89, 2.99). The proportion of variability accounted for in the final regression model was 0.25. Factors positively associated with AF documentation (increase in difference between estimated and documented), were patients 65–74 years, 75 years +, Black or South Asian ethnicity, diabetes mellitus and practices in East and Midlands of England. Eight variables (female patients, deprivation score, heart failure and peripheral artery disease, total patients per practice, full-time GPs and nurses; and location in South of England) were negatively associated with AF documentation (reduction in difference). Conclusion Variations in AF documentation were predicted by several practice and population characteristics. Screening could target these sources of variation to decrease variation and improve AF documentation. [ABSTRACT FROM AUTHOR]

Several cross-sectional studies are conducted to analyze the different features of primary health care that is related to the coronary heart disease (CHD) mortality. An increase in the detection of hypertension is shown to lead to lower CHD mortality in patients.

Background Worldwide, high systolic blood pressure is the leading risk factor for deaths and disability-adjusted life-years but has been historically under-detected. This study aimed to quantify differences between estimated and practice-detected prevalences of hypertension across English general practices, and to determine how variations in detected prevalence could be explained by population-level and service-level factors. Methods Descriptive statistics, pair wise correlations between the independent variables and a multivariable regression analysis were undertaken. In the regression model, the outcome was detected hypertension prevalence, adjusted for estimated prevalence, person-related and disease-related determinants of illness and characteristics of general practices. Results Detected prevalence was substantially lower than estimated prevalence (mean difference 16.23%; standard deviation 2.88%). Higher detected prevalence was associated with increased deprivation, increased non-white ethnicity and urban location. Lower detected prevalence was associated with larger list sizes, more general practitioners and being located in the South outside London. The final multivariable model's adjusted R 2 value was 0.75. Conclusions Substantial under-detection of hypertension is widespread across England. Independent of estimated prevalence, factors associated with greater morbidity and population density predicted higher detected prevalence. Identifying patients with undetected hypertension and coordinating care for these patients will require further resources and logistical support in community settings. [ABSTRACT FROM AUTHOR]

Background: NHS general practice payments in England include pay for performance elements and a weighted component designed to compensate for workload, but without measures of specific deprivation or ethnic groups.Aim: To determine whether population factors related to health needs predicted variations in NHS payments to individual general practices in England.Design and Setting: Cross-sectional study of all practices in England, in financial years 2013-2014 and 2014-2015.Method: Descriptive statistics, univariable analyses (examining correlations between payment and predictors), and multivariable analyses (undertaking multivariable linear regressions for each year, with logarithms of payments as the dependent variables, and with population, practice, and performance factors as independent variables) were undertaken.Results: Several population variables predicted variations in adjusted total payments, but inconsistently. Higher payments were associated with increases in deprivation, patients of older age, African Caribbean ethnic group, and asthma prevalence. Lower payments were associated with an increase in smoking prevalence. Long-term health conditions, South Asian ethnic group, and diabetes prevalence were not predictive. The adjusted R2 values were 0.359 (2013-2014) and 0.374 (2014-2015). A slightly different set of variables predicted variations in the payment component designed to compensate for workload. Lower payments were associated with increases in deprivation, patients of older age, and diabetes prevalence. Smoking prevalence was not predictive. There was a geographical differential.Conclusion: Population factors related to health needs were, overall, poor predictors of variations in adjusted total practice payments and in the payment component designed to compensate for workload. Revising the weighting formula and extending weighting to other payment components might better support practices to address these needs. [ABSTRACT FROM AUTHOR]

Several letters to the editor are presented in response to the article "Association of features of primary health care with coronary heart disease mortality," by L. S. Levene and colleagues published in a 2010 issue.