Advantages of the SLICC
The St Leonard's index of Continuity of Care (SLICC) is a good measure for continuity measurement within general practices because it is:
1. inclusive- no patients or consultations excluded.
2. Straightforward to calculate and understand.
3. Suitable for tracking continuity improvement as it can be used to generate monthly measurements.
Inclusive continuity measurement
The SLICC is the only measure using every consultation by every patient with every GP- so every patient counts. As it uses the list, not the patient as the unit of measurement, it avoids excluding some GP consultations which can be a problem with other measures. For example: if three are needed for consideration as in some uses of the Bice Boxerman or UPC, this can amount to 31% of all GP consultations if one year is the timeframe. Such exclusions undercount and so undervalue GP continuity.
Simple to understand
The SLICC is the simplest available measure and is immediately understood by GPs and staff. The underlying basis is easy to explain unlike the complicated formulae for the Bice-Boxerman or the Herfindahl-Hirschman index.
It was designed in general practice with professional relationships in mind whereas the Herfindahl-Hirschman was designed to measure the market share captured by competitive companies.
Continuous measurement
The SLICC is useful over relatively short periods of time ie 3 months- other systems need longer time, detects a GP away on holiday for a fortnight.
It works independently of the number of consultations and avoids the distortion of results clustering at 0.5 as in the UPC.
SLICC data can be used in run (statistical control) charts; St Leonard’s used these in its Continuity Counts project report to the Health Foundation in 2021.
It is difficult to improve GP continuity without measuring it as changes need to be tracked to discover whether improvements are being made or not!
Published results for the SLICC from several general practices are available on Health Select Committee website for individual practices and in Sidaway-Lee et al (2019) BJGP.
