Sustaining named GP continuity requires organisational change: comparative implementation analysis in Finland.

Abstract

Maintaining doctor-patient relationship continuity remains a challenge in public primary care in Finland and internationally due to general practitioner (GP) workforce pressures and organisational constraints. To evaluate implementation of a named GP model and explain differences in implementation outcomes between two Finnish primary care units. A quasi-experimental before-after study was conducted in two Finnish primary care units with contrasting organisational settings. Patients were assigned a named GP responsible for non-urgent care. Electronic health record data covering physician consultations over 48 months were analysed. Continuity was measured using the Usual Provider of Care Index (UPC), the St Leonard's Index of Continuity of Care (SLICC), and the Own Patient Ratio (OPR). Implementation outcomes were interpreted using the RE-AIM framework. A segmented Interrupted Time Series (ITS) model was applied to OPR and SLICC, and UPC analysed using a pre-post design. Named GP continuity was higher in Tuira than in Pudasjärvi across all measures. In Tuira, adoption (OPR 0.88) was high and stable with lower named GP-level variation, while reach (SLICC 0.31) and effectiveness (UPC 0.35) improved but remained modest. Although continuity improved in Pudasjärvi, adoption remained weaker (OPR 0.40), reach lower (SLICC 0.16), and maintenance less stable. Continuity of care with physicians other than the named GP increased more in Pudasjärvi. The named GP model was functionally adopted in Tuira but remained largely nominal in Pudasjärvi. Health systems implementing named GP models should prioritise sustained GP presence and organisational alignment to achieve continuity.