Controversy in primary care: Does continuity in general practice really matter? Commentary: A patient's perspective of continuity

Abstract

# Does continuity in general practice really matter? {#article-title-2} Continuity is an official core value of general practice in the United Kingdom,1 but there are at least two potentially conflicting definitions of it. Both definitions are powerfully expressed in a recent report from the BMA, entitled Shaping Tomorrow .2 For general practitioners, continuity of care has traditionally meant that a patient visits the same doctor. 3 4 What matters is personal continuity, in which an ongoing doctor-patient relationship ensures that care takes account of the patient's personal and social context. By contrast, recent statements from the NHS Executive emphasise the importance of consistency and coordination of care.5 From this perspective, continuity can be enhanced by appropriate organisation, guidelines, and electronic medical records, irrespective of which doctor is seen. #### Summary points Continuity, in the sense of visiting the same doctor, is a core value of general practice in the United Kingdom It is increasingly presented as “old fashioned” and in opposition to the development and modernisation of primary care The implicit choice between personal continuity and modern care is false; what evidence there is suggests that patients prefer services providing personal continuity, and this may also reduce the use of investigations and admissions to hospital If general practitioners really believe that it matters that a patient visits the same doctor, they need to ensure that this is taken into account in the development of primary care Most research about the impact of continuity of care has been conducted in antenatal care or in specialist care settings in the United States.6-10 Generalising these results to general practice in the United Kingdom is possible but problematic. Research shows that a patient's enablement and satisfaction with a consultation is strongly associated with visiting the same doctor.11-13 Patient satisfaction is also higher in practices that are small, non-training, or have personal …