It was a pleasure to read Helen Richard's Personal View and her
defense of personal continuity in Primary Care. it is a subject long
debated and it must be acknowledged 'personal lists' can mean more than
one form of arrangement. Nevertheless, it is a topic that has particular
meaning for current general practice with our political masters stressing
access and choice ahead of continuity of care.
There seems little doubt that personal continuity with one doctor is
valued by patients, particularly those with chronic disease. Little doubt
too that doctors themselves value continuity and find it professionally
satisfying. But is it better for general practice?
Those working in Primary Care know that there are huge organisational
problems mitigating against personal doctoring. Also, those practices that
think that they are offering continuity may not be, or at least be
offering, at best, a fragmented version. That is no reason though to ditch
the idea. The fact that continuity is harder to engineer and even harder
to measure does not mean it is of any less importance than speedy access.
Over thirty years in general practice taught me that most problems aren't
immediate, though to recognise the ones that are is of great importance.
Without continuity there is inevitably discontinuity. That too has its
down side -the more individuals involved in somerone's care the greater
the likelihood of errors, the less likely emotional problems are
adequately addressed and the more likely a relationship of trust (surely
the cornerstone of practice)fails to establish itself. Fourteen years
working with the Medical Defence Union, and longer still in the Courts,
has taught me the personal cost of discontinuous care.
The topic ought to be debated much more than it is in Journals like
this one and amongst those in position of influence such as the RCGP and
the BMA.Practices themselves need to make their views heard, now, before
government policy makers make personal continuity a thing of the past.
Rapid Response:
Continuity natters
It was a pleasure to read Helen Richard's Personal View and her
defense of personal continuity in Primary Care. it is a subject long
debated and it must be acknowledged 'personal lists' can mean more than
one form of arrangement. Nevertheless, it is a topic that has particular
meaning for current general practice with our political masters stressing
access and choice ahead of continuity of care.
There seems little doubt that personal continuity with one doctor is
valued by patients, particularly those with chronic disease. Little doubt
too that doctors themselves value continuity and find it professionally
satisfying. But is it better for general practice?
Those working in Primary Care know that there are huge organisational
problems mitigating against personal doctoring. Also, those practices that
think that they are offering continuity may not be, or at least be
offering, at best, a fragmented version. That is no reason though to ditch
the idea. The fact that continuity is harder to engineer and even harder
to measure does not mean it is of any less importance than speedy access.
Over thirty years in general practice taught me that most problems aren't
immediate, though to recognise the ones that are is of great importance.
Without continuity there is inevitably discontinuity. That too has its
down side -the more individuals involved in somerone's care the greater
the likelihood of errors, the less likely emotional problems are
adequately addressed and the more likely a relationship of trust (surely
the cornerstone of practice)fails to establish itself. Fourteen years
working with the Medical Defence Union, and longer still in the Courts,
has taught me the personal cost of discontinuous care.
The topic ought to be debated much more than it is in Journals like
this one and amongst those in position of influence such as the RCGP and
the BMA.Practices themselves need to make their views heard, now, before
government policy makers make personal continuity a thing of the past.
Competing interests:
None declared
Competing interests: No competing interests