Mapping quality of primary care among 0.5 million people with multiple long-term conditions in England, 2015–2024: a retrospective cohort study using electronic health records
File(s)
Published version (article in press)
Author(s)
Type
Journal Article
Abstract
Background
As the number of people with multimorbidity continues to increase, the traditional medical care model – based on single disease models - has become increasingly unsuitable to meet current challenges, leading to concerns about the quality of primary care for patients with multimorbidity. This study aimed to evaluate the quality of care for people with multimorbidity in primary care, using quality indicators identified in Electronic Health Records (EHR) data.
Methods
This study used EHR from the Discover-NOW Hub for April 2015–2024, covering 95% of northwest London’s population. Through review of literature and clinical guidelines, we identified eight generic and six multimorbidity-specific quality indicators (QIs) for primary care, with consideration of the availability of indicators within EHR data. The final list was derived following discussion with people with lived experience of multimorbidity and clinicians. We used heat maps to report the QI attainment levels and conducted Ordinary Least Squares and logistic regression analyses to assess sociodemographic and health-related inequalities in relation to generic and multimorbidity-specific QI.
Results
This study included 509,782 adult patients with multimorbidity. Attainment on generic QIs (range 23.5%-79.8%) was generally higher than multimorbidity-specific indicators (< 30%). QIs were generally stable over the past decade, but significantly reduced during the COVID-19 pandemic and fluctuated across individual QIs. Compared with healthier multimorbidity groups, those living with more comorbidities, polypharmacy and more severe frailty had higher levels of QI scores and had higher odds of uptake of individual QIs. Notably, we found socioeconomic inequalities, especially regarding ethnicity and neighbourhood deprivation, though this varied by QI.
Conclusions
This study provides real-world evidence of the quality of primary care among multimorbidity patients. There was lower attainment on multimorbidity-specific QI than general indicators, with less affluent and some minority ethnic groups less likely to receive good care. Policymakers should focus on approaches to improve the support of primary care clinicians in the delivery of person-centred care for individuals with multimorbidity. Further research is needed to explore the underlying mechanisms for differential QI attainment and support primary care teams to improve the quality of care for people with multimorbidity.
As the number of people with multimorbidity continues to increase, the traditional medical care model – based on single disease models - has become increasingly unsuitable to meet current challenges, leading to concerns about the quality of primary care for patients with multimorbidity. This study aimed to evaluate the quality of care for people with multimorbidity in primary care, using quality indicators identified in Electronic Health Records (EHR) data.
Methods
This study used EHR from the Discover-NOW Hub for April 2015–2024, covering 95% of northwest London’s population. Through review of literature and clinical guidelines, we identified eight generic and six multimorbidity-specific quality indicators (QIs) for primary care, with consideration of the availability of indicators within EHR data. The final list was derived following discussion with people with lived experience of multimorbidity and clinicians. We used heat maps to report the QI attainment levels and conducted Ordinary Least Squares and logistic regression analyses to assess sociodemographic and health-related inequalities in relation to generic and multimorbidity-specific QI.
Results
This study included 509,782 adult patients with multimorbidity. Attainment on generic QIs (range 23.5%-79.8%) was generally higher than multimorbidity-specific indicators (< 30%). QIs were generally stable over the past decade, but significantly reduced during the COVID-19 pandemic and fluctuated across individual QIs. Compared with healthier multimorbidity groups, those living with more comorbidities, polypharmacy and more severe frailty had higher levels of QI scores and had higher odds of uptake of individual QIs. Notably, we found socioeconomic inequalities, especially regarding ethnicity and neighbourhood deprivation, though this varied by QI.
Conclusions
This study provides real-world evidence of the quality of primary care among multimorbidity patients. There was lower attainment on multimorbidity-specific QI than general indicators, with less affluent and some minority ethnic groups less likely to receive good care. Policymakers should focus on approaches to improve the support of primary care clinicians in the delivery of person-centred care for individuals with multimorbidity. Further research is needed to explore the underlying mechanisms for differential QI attainment and support primary care teams to improve the quality of care for people with multimorbidity.
Date Issued
2026-07-10
Date Acceptance
2026-05-27
Citation
BMC Medicine, 2026
ISSN
1741-7015
Publisher
BMC
Journal / Book Title
BMC Medicine
Copyright Statement
© The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Publication Status
Published online
Date Publish Online
2026-07-10