FOR HEALTH PROFESSIONALS
“IS CONTINUITY POSSIBLE IN THE CURRENT SITUATION WITH A SHORTAGE OF GPS, PART TIME WORKING, AND LARGER, MORE MULTIDISCIPLINARY PRACTICES?”
Yes, there are practices of all sizes, in different regions of the UK and in areas of varying social deprivation providing good, measured levels of continuity of care (at least 50% of consultations with the named GP). Most of these practices use personal lists so that each patient has a named GP and the practice works towards ensuring that patients have their GP appointments with their own GP whenever possible. We discuss this in more depth in our article: Can general practice still provide meaningful continuity of care?
"WHY PERSONAL LISTS?"
To improve continuity, everyone in the practice needs to know (or be able to quickly check) which GP each patient should see. Then the patient needs to be helped and encouraged to see that GP as frequently as possible. This is a personal list. Currently, there are thousands of GP appointments per day being provided for patients who do not know the GP and who may not see that GP again. If even some of these could be re-directed so that more GP appointments are with patient’s own GP, there are likely to be important efficiency savings (Kajaria-Montag et al 2023).
“CAN YOU HAVE CONTINUITY WITH A TEAM RATHER THAN ONE GP?”
There is emerging evidence that continuity with more than one GP is possible and that it is likely to be associated with some of the same benefits as continuity with only one GP. There are practices which use a buddy system in which there is a primary named GP and then a second GP who patients are encouraged to see when their main GP is unavailable. Some have GP microteams meaning that all GPs in the team work together with a defined patient list. This can reduce the number different GPs a patient consults which is probably beneficial.
“WHAT ABOUT CONTINUITY WITH OTHER MEMBERS OF THE MULTIDISCIPLINARY TEAM?”
Continuity with other healthcare professionals is likely to be a positive thing and seeing someone familiar may be good for patient satisfaction. However, in general practice, there is most evidence for doctor continuity. The GPs are also the team members with the greatest potential to influence the patients’ care, as they have studied for longer, have a greater depth of knowledge and are best placed to take a whole-person perspective on care.
FOR PATIENTS
“I’M YOUNG AND USUALLY HEALTHY- DO I NEED CONTINUITY OF CARE?”
Younger, healthier people who rarely visit their doctor are less likely to experience the benefits of continuity. However, if a doctor gets to know you while you are young and healthy this may be useful later if you develop and on-going health problem.
“SURELY THE PRACTICE RECORDS HAVE ALL MY DETAILS ANYWAY?”
Although doctors do their best to write the important facts, it isn’t possible to include the whole of a consultation in the notes. Some things such as how a patient normally looks or talks, can’t be adequately recorded but doctors may remember if they see the patient again.
“SHOULDN’T I SEE ANY DOCTOR RATHER THAN WAIT FOR MY OWN DOCTOR?”
Sometimes, if you need urgent care and your doctor is not available. However, if possible try to see your own doctor as they will know you better and be able to provide better care.
“WHY IS THE NHS NOT MAKING CONTINUITY A PRIORITY?”
Current policies favour access over continuity, partially because this is what patients have asked for. However the evidence for benefits of good continuity is stronger than for improved access. In addition, a focus on access usually reduces continuity while a focus on continuity might actually improve access through efficiency savings.