We hear lots about how patients value the relationship with their GP, and how often they find it difficult to get an appointment with their preferred GP. Putting up with a long wait, often a week or two, may be acceptable but if the trade off is more anxiety then many will see someone else, perhaps a “duty doctor”, as a compromise.
Many doctors have told us that relational continuity is important for them too. We wanted to find out how often it was important, how often achieved, and how the patient age affected the answer. We need to go beyond the clichés of “the young only care about access” or “the elderly always want the same doctor” and quantify the relationship.
This study has n=13,150 responses from GPs in 27 practices, answering the question at the end of each consultation, was continuity important? Yes, and achieved (blue); Yes, not achieved (red) or No, not important (green). Patient age and sex were recorded.
The answers are clear. Overall, GPs felt that continuity was important in around half of all consultations, rising from 20% with children under 10 to 60% for patients over 70. The clichés contain a grain of truth, that in the view of GPs continuity is more likely to be important for the elderly than for young adults and children. But the relationship can be important at all ages. Interestingly, asking patients whether they had a preferred GP for a consultation has yielded a similar answer, about half the time.
The implication is that systems of access in general practice need to enhance continuity for all patients. Around half the time a choice of GP can make an important difference, and half the time it doesn’t matter. Access and continuity are often described as mutually exclusive, but our findings are contrary to this. Only when the lid is taken off access can continuity be restored.
First presented at King’s Fund conference on “The Future of Primary Care”, 12 September 2013.