Can general practice still provide meaningful continuity of care?

General practice is in crisis with falling numbers of general practitioners and low morale. For the first time, more patients are dissatisfied than are satisfied with general practice.1 National policies to deal with the crisis include the NHS workforce plan and deploying other health professionals into practices, but the potential of enhanced continuity of care to ameliorate professional and public discontent has been largely overlooked. Though definitions of general practice continuity of care differ,2 relational continuity—when a patient sees the same GP repeatedly, regardless of also seeing other professionals—generates trust among patients.3 Longitudinal continuity (being registered with the same practice) fosters relational continuity over time and is the most important component enhancing GPs’ understanding of the patient’s context.

The General Practice Patient Survey shows that continuity for patients in the UK with their GPs has been falling, with a 27.5% decline between 2012 and 2017.4 Multiple factors contribute including a severe shortage of GPs, fewer GPs consulting five days a week, and national policies that focus on access times at the expense of continuity.

Although some people believe that continuity and fast access are incompatible, continuity may improve access overall by saving the total number of repeat appointments required.5 Furthermore, as more patients live longer with multiple, complex, chronic conditions, we argue that it is both possible and desirable for GPs to build strong therapeutic relationships with patients through continuity.