Continuity of care in diverse ethnic groups; a general practice record study in England

Background: General practitioners (GPs) and patients value continuity of care. Ethnic differences in continuity could contribute to inequalities in experience and outcomes but few studies use routine health data to assess this. Aim: Describe relational continuity of care in general practice by ethnicity and long-term conditions. Design and Setting: 381,474 patients in England from a random sample from Clinical Practice Research Datalink, January 2016 to December 2019. Method: Face-to-face, telephone and online consultations with a general practitioner were included. Continuity, measured by the Usual Provider of Care and Bice-Boxerman indices, was calculated for patients with ≥3 consultations. Ethnicity was taken from the GP record or linked Hospital Episode Statistics and long-term conditions were counted at baseline. Multilevel regression models described continuity by ethnicity sequentially adjusted for i) number of consultations, follow-up time, age, sex and practice-level random intercept, ii) socioeconomic deprivation in the patient’s residential area, iii) long-term conditions. Results: On full adjustment, five of ten ethnic minority groups (Bangladeshi, Pakistani, African, Caribbean, and other Black) had lower continuity of care compared to white patients. Continuity was lower for patients in more deprived areas and younger patients but this did not account for ethnic differences in continuity. Similar ethnic differences were seen for patients with ≥2 long-term conditions. Conclusion: Ethnic minority identity and socioeconomic deprivation have additive associations with lower continuity of care. Structural factors affecting demand for, and supply of, general practitioners should be assessed for their contribution to ethnic inequalities in relational continuity and other care quality domains.