A regular GP helps you live longer: Study

Dr Michael Bonning knows the rewards of having a regular GP.
 
The Sydney-based GP had a 70-year-old male patient who presented with a persistent cough. He had seen multiple different providers and practitioners over this time, but no one had been his regular doctor.
 
‘We went all the way back when this cough started 15 years ago,’ Dr Bonning told newsGP.
 
‘If [a patient] with a cough sees different providers over the years, such as a pharmacist, a nurse-led clinic, a GP once, a different GP again, everyone says, “Oh well, you’ve got a cough, it’ll settle down, or try this, or do that”.
 
‘After I spent more than 20 minutes with him and started getting some idea of the long-term nature of the problem which had plagued him for years, he settled really well on some very simple interventions.
 
‘So it was building a relationship with this guy, and … we now have an understanding of what’s going on and we want to fix this and work with him for the next 15 years of his life.’
 
Dr Bonning, who sits on the RACGP Expert Committee – Funding and Health System Reform and is President of AMA NSW, provided this example in response to new research from the UK which demonstrates the importance of continuity of care, including that seeing the same GP increases life expectancy.
 
Published in the British Journal of General Practice, the study highlights that the number of GPs, continuity of care, and access to care in England are all declining, despite evidence showing that living in areas with more fully qualified GPs and better-funded clinics has a positive impact on life expectancy.
 
Results showed that higher patient rebates, full-time equivalent GPs per 1000 patients and continuity of care are associated with higher life expectancy, while deprivation was ‘strongly negatively’ associated with life expectancy – mirroring outcomes in Australia.
 
Dr Bonning said the study is relevant to Australian general practice, and how primary care interacts with the whole health system.
 
‘Having a GP is correlated with better life expectancy,’ he said.
 
‘That’s always a huge positive, and we know that long-term continuity builds … value to the health system, but also the value to the individual of the privacy of that relationship between GP and patient over the longitudinal timeframe.’
 
When it comes to chronic disease, Dr Bonning said continuity is of particular importance.
 
‘Given the majority of disease burden that we see in the community is chronic, with obviously acute exacerbations, we need to have the same team and/or same person as the direct conduit of information of support of the systems with decision making and of the provision of interventions,’ he said.
 
‘That all drives better care and better outcomes.
 
‘It means that we are better for our interventions, we’re better for our diagnosis. We can watch and intervene earlier but also understand how conditions evolve in individuals.’
 
Again, using the case of the 70-year-old with the cough, Dr Bonning said GPs also have a vested interest in wanting their patient to be better.
 
‘Hopefully he will now be my patient for the next 15 years of his life,’ he said.
 
‘I get feedback on the interventions, he comes back in six weeks’ time and says, “No that one didn’t work.” I say, “Okay, let’s go back to the drawing board and think about it again.”
 
‘But on the flip side, when we do get positive responses, he then builds trust in me with regards to all those other things, like “My knees really hurt, can you also help me with that?”, because he’s seen me help him with something already.’

Dr Michael Bonning says the role GPs play and trust they have with patients gets diminished by fragmentation of care. (Image: Facebook/University of Queensland)
 
The UK research was released amid the Australian Government’s Scope of Practice review, with the second issues paper expected to drop this week.
 
The RACGP has referenced growing member concern at reforms that will prioritise convenience over continuity of care, while also warning that its apparent direction could reproduce ‘a failed’ UK model that fragmented the system and shifted GPs’ roles to other health professionals without adequate training.
 
And while convenience is important, Dr Bonning emphasises that access to a GP is critical.
 
‘For an issue that a patient might have, not being able to see them for six weeks is, in some ways, just as bad as not having a GP, because an issue may have really been exacerbated,’ he said.
 
‘We diminish the role of the GP by making it that others are in a position to take pieces from the GP’s role but forget that the role of the GP is greater than the sum of the parts.
 
‘What I do for a patient with a flu vaccine – maybe there’s some counselling and some motivational interviewing – it’s not those three things, it’s the relationship that those things build. And that is the role we play and why continuity is so important.
 
‘Because it’s not just the things we do, it’s the role we play and the trust we have, and that gets diminished by fragmentation.’
 
The UK research also points to an issue familiar to the Australian general practice landscape: the GP workforce.
 
Professor Kamila Hawthorne, Chair of the Royal College of GPs, said the UK does not have enough GPs to ‘deliver the care that all patients deserve’, with the impacts greater in more deprived areas.
 
‘We need to ensure GPs and our teams can deliver the continuous care our patients need now, and in the future, by guaranteeing that we’re properly resourced and funded,’ she said.
 
A similar narrative has long been playing out in Australia, and Dr Bonning said the study helps to further shine light on the issue and the importance of recruitment and retention in general practice to strengthen an ailing workforce.
 
He reiterates the need for better investment in primary care, including increasing incentives for people to be able to see their GP, with Medicare item number rates historically lagging behind inflation and not keeping pace with the costs of delivering care.
 
‘Investing in primary care enshrines those benefits that we see of continuity in achieving that whole-of-population health,’ Dr Bonning said.
 
‘It’s also about the importance of potential future GPs in recognising that while other specialties have their things, we actually deliver incredible outcomes to patients by being by their side through their life.
 
‘And that’s the part we need to recognise – the life-saving element of primary care, specifically general practice, will start to be lost if we only focus on consumer convenience. Patient choice is important, but it’s not the only thing that’s important.
 
‘High-quality care delivery is something that needs to be funded, and the more funding we put into other things and take away from general practice, we will end up undermining what has been a historically very strong primary care environment in Australia that has delivered world-leading health outcomes, great levels of primary prevention, and, usually considered among the top [10] life expectancies in the world.’
 
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continuity of care GP workforce GP–patient relationship life expectancy scope of practice