Dementia patients who see the same GP every time have lower rates of health complications, fewer emergency hospital visits and a better overall quality of life, according to a new study.
More than 900,000 people live with dementia in the UK. The figure is about 57 million globally, and this is on course to nearly triple to 153 million by 2050.
The University of Exeter research – published in the British Journal of General Practice – analysed records for more than 9,000 people aged 65 and over in England living with dementia in 2016.
It found that people with dementia who were consistently seen by the same GP over the course of one year were given fewer medicines and were less likely to be given medicines that can cause problems like falls, incontinence and drowsiness.
Those seeing the same GP over time were 35% less likely to develop delirium, a state of confusion commonly experienced in dementia. Those who consistently saw the same GP were also 58% less likely to experience incontinence, and 10% less likely to have an emergency hospitalisation, compared with those who had the most variation in GPs treating them.
Delirium and incontinence are not only very distressing for patients, but additional hospital admissions can also be costly for the NHS, the researchers said.
“In the absence of a cure, long-term care is particularly important,” said the study’s lead author, Dr João Delgado of the University of Exeter. “Treating people with dementia can be complex, because it often occurs together with other common diseases.
“Our research shows that seeing the same GP consistently over time is associated with improved safe prescribing and improved health outcomes. This could have important healthcare impacts, including reduced treatment costs and care needs.”
Sir Denis Pereira Gray, study co-author and a GP researcher at Exeter’s St Leonard’s Practice, said the findings showed that having a named GP was associated with important benefits for patients.
“Whilst national policymakers have for years discouraged continuity, general practices can still provide good GP continuity through their internal practice organisation, for example by using personal lists,” he added.
Dr Richard Oakley, associate director of research at Alzheimer’s Society, said: “It’s clear from this study that consistently seeing the same GP has real benefits for people living with dementia – better management and treatment of conditions, and lower risk of complications like delirium and incontinence, leading to improved quality of life.
“The pandemic has put GP services under immense pressure, so while we might not be able to get consistent GP care for everyone with dementia tomorrow, policymakers should absolutely be working with the NHS to build this into their plans as we emerge from the pandemic.”
The study concluded that higher continuity of GP care for patients with dementia was “associated with safer prescribing” and “lower rates of major adverse events”.
“Continuity of care is highly valued by patients and GPs, and there is strong research evidence that it is associated with better outcomes for patients and more effective use of NHS services,” said Prof Martin Marshall, chair of the Royal College of GPs. “This research confirms these findings and shows it can be particularly beneficial for patients suffering from dementia.”
Marshall said although GPs wanted to provide the best care to all their patients, including continuity for those who want and value it, “escalating GP workload and workforce shortages” meant that it had become increasingly difficult to deliver.
He added: “Ultimately, what is needed in order to allow GPs to deliver continuity of care to those patients who value it is more GPs and more members of the practice team so that we can spend more time with patients. The government must urgently deliver on its manifesto pledge of 6,000 more GPs and thousands more members of the practice team so that GPs are able to give patients with dementia, and all their patients, the care they need and deserve.”