Better continuity of care with GPs for people with dementia who are in their final year of life can save the NHS money, according to new research from academics at the Cicely Saunders Institute, part of the Faculty of Nursing, Midwifery & Palliative Care at King's College London.
The study, published in the British Journal of General Practice, used data from adults with a diagnosis of dementia who died in England between 2009 and 2018, and found that those with better continuity of care with their GP cost the NHS less in their last 12-months of life than those with worse continuity of care.
Results from this large population-based cohort study suggest that increasing the level of continuity of care from zero (all contacts in the last year of life with a different GP) to one (all contacts with the same GP) could result in an average total cost reduction between £1,319 and £2,875 per person in the last 12 months of life.
Continuity of care refers to whether the contacts that a patient has with healthcare professionals are with the same person, or different people.
As end-of-life care and hospital costs increase rapidly the closer someone is to death, it is important to understand to what extent continuity of primary care may affect these costs.
When people with dementia had better continuity of care with their GP, this was associated with both lower GP practice costs and lower hospital costs due to them having fewer unplanned admissions. Therefore, improving continuity of primary care has potential to improve care for the individual, and lower costs for the overall system.
The recommendation emerging from the paper is to prioritise having appointments with the same GP among people with dementia who are in their last year of life. This could reduce unnecessary hospital admissions and costs by improving communication, the identification of patients' needs and a more person-centred approach to dementia end-of-life care.
Thinking about this research in context of the NHS's recent 10-year plan, the cost of implementing this recommendation might not be significant, as higher continuity of care was associated with lower GP practice costs. The plan is also focused on moving from sickness to prevention; the benefit for dementia patients approaching the end of their life of seeing the same doctor is that subtle changes in their condition are much more noticeable.
Professor Katherine Sleeman said "Unplanned hospital admissions are very common for people with dementia in their last months of life, and most people with dementia and their families would prefer to avoid hospital admission if possible. Improving continuity of primary care - seeing the same GP each time it's needed - has potential to improve care for people with dementia near the end of life and reduce overall costs for the NHS through reducing acute hospital use. These data add to the literature demonstrating the benefits of primary care continuity for both patients and the wider system."
