What future for continuity of care in general practice?
BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7098.1870 (Published 28 June 1997) Cite this as: BMJ 1997;314:1870
- George Freeman, professor of general practicea,
- Per Hjortdahl, professor of general practiceb
- a Department of Public Health and Primary Care, Charing Cross and Westminster Medical School, University of London, London SW10 9NH
- b Department of General Practice and Community Medicine, University of Oslo, N-0317 Oslo, Norway
- Correspondence to: Professor Freeman
- Accepted 27 March 1997
Introduction
Continuity of care has had many definitions,1 but in the context of general practice it is still virtually synonymous with care from one doctor, usually spanning an extended time and more than one episode of illness.2 Although this longitudinal continuity, with its implied personal relationship, is seen by many as a core feature of the discipline, there is little supporting evidence. Seeing the same doctor does not guarantee a good patient-doctor relationship, and in any case such continuity can no longer be taken for granted. In many countries it is being abandoned under pressure from modern developments in medicine, in organisation of practices, and in society generally. A recent report from the British General Medical Services Committee suggested that it is being replaced by continuity within the primary care team.3
The practical question is whether patients should be enabled as far as possible to see the doctor of their choice or whether to go further and state that they should normally see only one general practitioner because this is better for them. We think that current evidence does not support this last view. Instead general practitioners, primary care teams, managers, politicians, and the public need to develop a shared understanding of the strengths and drawbacks of continuity, which when allied with good communication we call personal continuity (box).
Definitions of continuity of care
Longitudinal continuity
Care given by one practitioner over a defined time
This has traditionally been a general practitioner practising alone
Much of the evidence for its benefit is from hospital outpatient settings
Personal continuity
An ongoing therapeutic relationship between patient and practitioner
Typically the patient will look to this practitioner as their most valued source of care
The nature and quality of the contacts are more important then the number
Longitudinal versus personal continuity
Longitudinal continuity is a simple concept with strong face …