What happens to patients when their GP retires or relocates?

This is an opinion piece that expresses the author’s viewpoint.

Norway introduced the Regular GP Scheme in 2001. It gave all citizens the right to choose a GP in their home municipality. This facilitates personal continuity between the doctor and the patient.

These types of long-term doctor-patient relationships are associated with reduced use of emergency health services and lower mortality, both internationally and in Norway.

A widely discussed Norwegian study from 2022 showed that patients who had the same GP for more than fifteen years had a 25 per cent lower risk of dying compared to patients who had the same GP for one year or less.

In addition, there has been an increasing shortage of GPs in recent years. As of July 2024, just over 188,000 people in Norway do not have a regular GP, representing almost 3.5 per cent of the country’s population.

Since long-term doctor-patient relationships appear to be more beneficial than short-term ones, the assumption can be made that losing your regular GP could be detrimental. You would end up in a group of people who have only known their GP for a short period of time.

However, many factors influence the contact and length of relationship with a GP, such as age, gender and health issues, as well as the fact that people can choose to change their GP up to twice a year.

These are traits and trends that are also related to health, healthcare use and mortality. It can therefore be difficult to distinguish the effect of a long-term doctor-patient relationship from the effect of other factors related to the patient.

It is not coincidental which patients switch their GPs more frequently and thus have shorter doctor-patient relationships. This group may include people with multiple health problems who feel they have been inadequately examined, leading them to seek more hospital referrals because of these issues – rather than just the doctor-patient relationship itself being the problem.

However, some disruptions to the doctor-patient relationship are coincidental, such as when the doctor goes on holiday, has mandatory hospital service, relocates or retires.

It is reasonable to assume that these disruptions have nothing to do with factors related to the patients, and thus it becomes possible to study the effect of losing a regular GP without the interference of factors that influence both the length of doctor-patient relationships and health outcomes.

Despite the shortage of GPs in many countries, few studies have been conducted on this topic.

Since Norway has exceptionally good data on its population, healthcare use, mortality and GPs, we were inspired to investigate the consequences of a GP leaving their position due to unavoidable personal circumstances.

Between 2011 and 2021, 819 GPs retired and 228 relocated between counties. We studied the impact on healthcare use and mortality over the course of five years by comparing the almost 1.2 million patients associated with these doctors to similar patients and GPs where there was evidence of a continuing relationship.

We found that for every 1,000 patients who lost their regular GP, there were 13 to 16 additional contacts with the out-of-hours medical service and hospital emergency departments in the first year. Over all five years, there were approximately 148 more contacts per year in general practice and 51 additional planned contacts in hospitals every year. Compared to the patients who continued with the same doctor, this represented a 3 to 5 per cent increase.

We found no difference in mortality rates between patients whose GP relocated or retired and those whose had not.

We conclude that there may be multiple reasons why having the same GP over time is beneficial for health, and that you would not be at risk if your GP were to relocate or retire.

The increase in healthcare use appears to be small to moderate, and the risk of mortality remains unaffected.

The findings are somewhat in contrast with much of the research on continuity. This indicates that studies on the duration and disruption of doctor-patient relationships are complex, requiring different research methods to shed light on various problems.

Reference:
Kristin Hestmann Vinjerui, Andreas Asheim, Kjartan Sarheim Anthun, Fredrik Carlsen, Bente Prytz Mjølstad, Sara Marie Nilsen, Kristine Pape, Johan Håkon Bjørngaard: General practitioners retiring or relocating and its association with healthcare use and mortality: a cohort study using Norwegian national data. BMJ Quality and Safety 2024