Problem Specification: Maintaining an ongoing relationship between a patient and provider, referred to as relational continuity (RC), is advocated as a cornerstone of primary care. Yet despite its many clinical and operational benefits, primary care RC has been in sharp decline over the past decades. This paper explores operational factors that explain variation in rates of RC between practices and over time.
Practitioner Audience: This paper helps practice managers to identify the root cause of low rates of RC at their own practice, the key operational levers that they can use to promote RC, and proposes strategies to mitigate the adverse effects of industry trends on RC. It also provides valuable insights for policymakers and health service commissioners who wish to incentivize primary care practices to safeguard RC.
Core Insight: We find that a sustained increase in workload caused by growth in demand relative to supply and increasing fragmentation of the workforce due to a shift to part-time and agency work can explain nearly 50% of the decline in RC over the past decade. These factors also cause significant heterogeneity to exist between practices in their ability to provide RC.
Practical Implications: Practice managers and policymakers must improve the attractiveness of full-time salaried employment if they wish to preserve RC. Mitigating the adverse effects of workload on the workforce is one helpful step towards achieving this. When growth in workload and workforce fragmentation are unavoidable, managers should attempt to preserve RC for patients who benefit from it most.