Are microteams the key to primary care continuity?

Continuity of care means that a patient regularly sees the same clinician or team. In primary care, this translates into the patient being allocated to a particular GP, referred to as a GP’s ‘personal list’.

The concept of a ‘personal list’ fosters a trusting relationship, enabling better communication and familiarity with the patient. The importance of continuity of care in the primary care setting has long been established, with benefits including improved patient outcomes (eg mortality), higher clinician satisfaction, reduced clinical burnout, and cost-effectiveness for the NHS.

“seeing your ‘own GP’ feels like a thing of the past for most patients”

Despite these benefits, continuity of care has taken a back seat in many practices due to increasing patient demand, a growing patient-to-GP ratio, health policies prioritising access over continuity, a reduction in GP numbers, and more GPs opting for part-time or portfolio careers. Consequently, seeing your ‘own GP’ feels like a thing of the past for most patients.

A practice trying a different model

As part of my research fellowship, I joined Living Well Partnership (LWP), a Southampton-based primary care network that operates as a single partnership across eight sites. It serves a population of 46,500 patients in an area with marked health inequalities. 

LWP identified a need to improve staff and patient satisfaction, enhance coordinated care, and boost continuity of care. So, in March 2023, LWP introduced a microteam model to prioritise continuity. 

While the concept has different definitions in the literature, the basic premise is that a microteam is a mini multidisciplinary team within a wider multidisciplinary team, which serves a particular patient group within a practice and could include any variety and number of professionals. Having this small group of specific individuals means patients are able to build long-term relationships with members of the microteam. At LWP, 12 microteams were formed, each led by a named GP (either partner or experienced salaried GP) responsible for a specific patient cohort. Each team delivers care through ten GP sessions per week, shared between two-to-three GPs including partners, salaried GPs and supernumerary trainees.

Care coordinators - the right hand of the team - support each microteam. They pick up the non-clinical but essential part of a GP’s role such as cancer care reviews, checking on patients and flagging to the team those of concern.

Measuring the impact

After the microteams model had been in place for a year, my supervisor, Dr Pritti Aggarwal, and I measured the impact of the change using the Usual Provider of Care (UPC) index, which calculates the proportion of appointments a patient has with the same clinician, focusing on patients with three or more appointments in a set period. A higher UPC percentage indicates better continuity, meaning patients are more likely to see the same GP or a member of their microteam, over time.

“After microteams were introduced, over a third of these patients consistently saw the same GP or a member of their microteam”

We compared UPC indices from the year before the microteams were introduced, with data from the first year of implementation. The results showed an increase in the UPC of approximately 956 per cent, from 3.39 per cent to 35.81 per cent. Despite the UPC index still being mediocre, such improvement is significant. In practical terms it means that before microteams, patients with ongoing health needs rarely saw the same clinicians. After microteams were introduced, over a third of these patients consistently saw the same GP or a member of their microteam. This led to stronger doctor-patient relationship, better understanding of individual health needs and improved continuity of care. Furthermore, the Quality and Outcomes Framework (QoF) achievement remained consistent across both years, and the introduction of microteams enhanced staff and patient satisfaction and improved care coordination.

While further exploration of data highlighted several confounding factors within the ever-evolving LWP that complicate isolating the exact impact of microteams on continuity of care, the improvement is nonetheless genuine and striking.

What this could mean for general practice

These preliminary results suggest that the microteam model can have an impact on continuity of care, even in a relatively short period. The model has the potential to raise all standards of practice, with practices starting from a low baseline potentially seeing the biggest gains. 

“For policymakers, these findings highlight the need to prioritise continuity alongside access”

For policymakers, these findings highlight the need to prioritise continuity alongside access. For practices, measuring continuity regularly as a performance index is valuable and emphasises the importance of structural changes to improve it. At LWP, continuity monitoring should become integral, with regular assessments to track progress and identify discrepancies between microteams. Additionally, incorporating care coordinators within microteams not only supports continuity but also releases clinical capacity.

A message for the future – a model to adopt?

The microteam model I describe here is a simplification to its now embedded nature at LWP, but it may not suit every practice. We all know that one size does not fit all, especially in primary care. 

While microteams may not be the only way to achieve better continuity of care, it is time for practices to consider the steps that could be taken to restore the ‘personal list’ and improve care through continuity.

I believe microteams offer an approach worth considering.
 

Dr Ioannis Saxionis is a GP registrar (GPST3) and patient safety fellow based in Southampton. He is also the outgoing exchange coordinator for the Junior International Committee (JIC) of the RCGP. You can connect with Ioannis on Linkedin