The New GP Contract needs continuity of care
The New GP Contract 2002, ‘Your contract Your future’, brings hope to
general practice (1,2). There is the promise of more time on patient
clinical care and less time on unnecessary bureaucracy. It is hoped that
the new quality targets will heed the accepted principles of screening and
reflect actual clinical practice (3). An end perhaps to the black market
of unproven national screening policies, such as isolated annual peak
flows for every single asthmatic or a dipstix urine test for every single
person over age 5yrs. The quality targets need to be very well designed to
avoid the pitfall of becoming next decade of bureaucratic hoops to jump
The biggest change in the New GP Contract 2002 is not the loss of
24hour responsibility, since that is already happening. It is the loss of
the registered patient list per general practitioner. This has been one of
the fundamental reasons why primary care in the UK has been ahead of other
countries. The understanding that you relate to one GP, in daytime hours,
provides a basis for building a continous relationship over the years so
that each consultation builds on the next.
Fortunately the concept of a registered patient list for a whole
general practice will be retained, but the risk is that the responsibility
for co-ordinating the care of each patient then falls between several
members of the practice. The personal list of general practitioners has
been the bedrock of continuity of care, something which general practice
has excelled at. Steps will need to be taken to ensure that both backstage
(administrative and IT) continuity and frontstage (face to face)
continuity is maintained (4). This reduces duplication of care, overuse of
resources and harm from unnecessary tests. Loss of continuity aggravates
doctors’ stress (5).
The current drive to rapid access to any doctor for minor illness has
already reduced continuity for more chronic complex illness by delaying
routine appointments up to several weeks. General Practices will need to
ensure each patient is allocated and encouraged to see a “usual” doctor
for any illnesses that will require care over time.
The New GP Contract 2002 does not mention continuity of care and this
should be emphasised in future versions as the contract moves towards its
final publication (2).
1) Kmietowicz, Z. GPs get a new contract "to transform their lives".
2) General Practitioners Committee Your contract Your future 2002
London: BMA publishing.
3) Wilson, J.M.G. and Jungner, G. Principles and practice of screening for
disease. 1968 Geneva: WHO.
4) Krogstad, U., Hofoss, D. and Hjortdahl, P. Continuity of hospital care:
beyond the question of personal contact. 2002 BMJ 324, 36-38.
5) Freeman, G.K., Horder, J., Howie, J.G.R., Hungin, A.P., Hill,
A.P., Shah, N.C. and Wilson, A. Evolviong general practice consultation in
Britain:issues of length and context. 2002 BMJ 324, 880-882.
Competing interests: No competing interests