Do practice deprivation scores predict declines in perceived relationship continuity? A longitudinal study.

Background Increased relationship continuity in primary care is associated with better health outcomes, greater patient satisfaction and fewer hospital admissions. Greater socio-economic deprivation is associated with lower levels of continuity, as well as poorer health outcomes. Aim To investigate whether deprivation scores predicted variations in the decline over time of patient-perceived relationship continuity of care, after adjustment for practice organisational and population factors. Design and Setting Observational study. Longitudinal multilevel linear model for 2012-2017 inclusive; 6,243 practices in England with more than one GP. Methods Relationship continuity was calculated using two questions from the General Practice Patient Survey. The effect of deprivation on the linear slope of continuity over time was modelled, adjusting for nine confounding variables (practice population and organisational factors). Clustering of measurements within general practices was adjusted for by modelling general practice as a random effect, using a random intercepts and random slopes model. Descriptive statistics and univariable analyses were also undertaken. Results Continuity declined by 27.5% between 2012 and 2017 and at all deprivation levels. Deprivation scores from 2012 did not predict variations in the decline of relationship continuity at practice level, after accounting for the effects of organisational and population confounding variables, which themselves did not predict (smokers, permanent disability and geographical location), or weakly predicted (Black or South Asian ethnicity, list size, over 75s, long-term conditions) with very small effect sizes, the decline of continuity. Crosssectionally, continuity and deprivation were negatively correlated within each year. Conclusion Deprivation scores did not predict decline in relationship continuity over time, which is persistent and widespread in English primary care.