Views & Reviews Personal View

We must defend personal continuity in primary care

BMJ 2009; 339 doi: (Published 06 October 2009) Cite this as: BMJ 2009;339:b3923
  1. Helen Richards, GP principal and partner, Inverness
  1. Helen.cowan3{at}

    The first challenge when defending continuity of care is to define it adequately. Theorists have suggested three types of continuity: informational continuity, which includes both formally recorded information and information residing in the memories of clinicians; management continuity, the application of care pathways and coordination of care; and relationship continuity, the clinician’s accumulated knowledge of each patient’s circumstances and preferences.

    To me—and I suspect to most GPs—personal continuity includes elements of all three but also goes further. Personal continuity means taking responsibility for the care of registered patients over an extended period of time; being the first point of contact in most episodes of illness; understanding the patient’s health in the context of their family, social networks, and wider community; and coordinating care in an increasingly complex healthcare system.

    Personal continuity is valued by patients, especially those with multiple morbidities, convoluted health narratives, and complex social circumstances and by those whose communication problems make it burdensome to repeat their stories. Continuity of caring contributes to GPs’ professional fulfilment, but less well …

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