The health and safety watchdog said patients should be seen by the same GP to ensure their safety.
An inquest into the death of a 67-year-old man who saw eight different GPs has warned that lack of access to the same doctor risks harming patients.
The Healthcare Safety Investigations Board (HSSIB) said ensuring doctors provide continuity of care should be included in the GP contract to “improve patient safety”.
A study published last year by King’s College London and Queen Mary University of London found that only 52 per cent of patients had a traditional family doctor they saw regularly, while a YouGov survey commissioned by Rebuild General Practice found that three quarters of patients had consistent treatment. It turns out that seeing is useful. Go to the same doctor.
Shadow Health Secretary Wes Streeting said that under the Labor government he would give financial incentives to GPs to allow patients to see the same doctor.
The 67-year-old man, known only as Brian, was diagnosed with breast cancer in 2008 but recovered, but the disease returned and spread to his spine, leading to his death. Breast cancer is rare in men, occurring in less than 1 percent of cases and affecting about 370 men a year.
Brian first visited his GP in April 2018 with “back pain” but was not diagnosed with cancer until scans in the emergency department in August 2020 revealed a tumor that had spread to his back and was pressing on his spinal cord.
At this point he could only be provided with end-of-life care.
Over the course of two years, Brian had appointments with at least eight different GPs, two out of hours and six in his practice, a nurse, two physiotherapists (doctors thought his pain was musculoskeletal in origin) and at least two visits to emergency rooms. , was told at the first opportunity that if he returned he would be “fined for wasting time.”
In the inquiry, which did not seek to incriminate but used examples to highlight national issues, GPs were told they “did not have enough time” to review medical records as part of the 10-minute consultation window allocated to each patient.
They said they “had the time it took for the patient to walk to the examination room after being called.”
Brian’s family told researchers that “doctors did not fully consider their concerns” and “raised the concern of ‘breast cancer returning’ at every GP appointment”.
A cancer specialist said in the study that when breast cancer spreads, “it is known to spread to the spine as well” and that cancer is more common in patients with a history of cancer.
Patient safety recommendations
The watchdog said “building clinician-patient relationships” and “ensuring continuity of information” are key to improving patient safety.
He said GPs were currently not required to secure surgeries that provided continuity of care, and this could include having detailed patient notes for another doctor to take the time to assess before seeing the patient.
HSSIB’s research uncovered a range of issues preventing patients from accessing the same GP, including GP workload, issues with IT systems and how notes are displayed, and differences in practice across the country.
He made two official recommendations; The first of these, given to the Ministry of Health, was to “ensure that the GP contract clearly includes and supports the need for GP practices to ensure continuity of care”.
The second, given to NHS England, was an update to how IT systems communicate information about returning patients with “unresolved symptoms”.
‘It was incredibly sad’
Senior safety researcher Neil Alexander said: “What struck our team during the research was that there were clear differences in patient experience and GP wellbeing between practices that implemented a continuity of care model and practices that did not.
“It has become clear to us that for GP practices to consistently prioritize continuity of care, it needs to become part of the core services they must offer.
“Brian’s case was a striking example of what can happen when this continuity is broken; It was incredibly sad for him and his family.
“He told our team, ‘When I’m gone, no one else should have to go through what I went through.'”
An NHS spokesperson said: “GP teams are carrying out a record number of appointments for half a million more patients each week than before the pandemic, and teams are working hard to ensure patients see the right clinician based on clinical need and preference.
A Department of Health spokesperson said: “Continuity of care is important and all patients should be assigned to a specific GP. Practices should try to comply with all reasonable requests from patients to see a specific GP or other healthcare professional, and people have the legal right to choose which practice they register with.”