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

Stafford, M., Bécares, L., Hayanga, B. , Ashworth, M. & Fisher, R. (2023). Continuity of care in diverse ethnic groups: a general practice record study in England. British Journal of General Practice, 73(729), e257-e266. doi: 10.3399/bjgp.2022.0271


Background: GPs and patients value continuity of care. Ethnic differences in continuity could contribute to inequalities in experience and outcomes.

Aim: To describe relational continuity of care in general practice by ethnicity and long-term conditions.

Design and setting: In total, 381 474 patients in England were included from a random sample from the Clinical Practice Research Datalink (January 2016 to December 2019).

Method: Face-to-face, telephone, and online consultations with a GP 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 data, and long-term conditions were counted at baseline. Multilevel regression models were used to describe continuity by ethnicity sequentially adjusted for: a) the number of consultations, follow-up time, age, sex, and practice-level random intercept; b) socioeconomic deprivation in the patient’s residential area; and c) long-term conditions.

Results: On full adjustment, 5 of 10 ethnic minority groups (Bangladeshi, Pakistani, Black African, Black Caribbean, and any other Black background) had lower continuity of care compared with White patients. Continuity was lower for patients in more deprived areas and younger patients but this did not account for ethnic differences in continuity. Differences by ethnicity were also seen in 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, GPs should be assessed for their contribution to ethnic inequalities in relational continuity and other care quality domains.

Publication Type: Article
Additional Information: This article is Open Access: CC BY 4.0 licence (
Publisher Keywords: continuity of care; ethnicity; general practice; inequalities; multiple long-term conditions.
Subjects: G Geography. Anthropology. Recreation > GF Human ecology. Anthropogeography
H Social Sciences > HN Social history and conditions. Social problems. Social reform
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments: School of Health & Psychological Sciences
School of Health & Psychological Sciences > Healthcare Services Research & Management
SWORD Depositor:
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