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We have to defend continuity of care in general practice

Continuity of care is a fundamental tenet of general practice that must be protected, writes Dr Krishna Kasaraneni ahead of the conference of LMCs in England

12 dr krishna kasaraneni power50 2016

What’s special about general practice? If you ask five GPs that question you are guaranteed to get about 20 different responses. While they will all have their own reasons, most of them will include one thing – and that is continuity of care.

The biggest strength of general practice is the independence it offers GPs to look after their patients in the way that’s needed, whilst providing them with continuity of care that is rarely seen in any other area of the health service. Indeed, in a survey by the BMA, 80% of GPs highlighted this as one of the elements of general practice that they valued the most.

I have to be honest and say that this was not something I had spent a lot of time thinking about in the past. Having recently moved surgeries so that I can work closer to home, I found meeting ‘new’ patients for the first time and not knowing any of them a very odd experience.

Three months in, I am slowly getting to know them. Call me old fashioned, but I love it when an interaction between a doctor and a patient is more than a one-off consultation about a medical problem. A relationship that builds with every consultation, a relationship that improves patient care and one that makes me go home wanting to come back the next day. It stops patients from being over-medicalised and allows us to look after them as a person rather than a medical problem. That is what is special about general practice.

Policymakers seem to focus on access at the expense of this key tenet of general practice

I can quote any amount of research showing:

Sadly though, some policymakers seem to focus on access at the expense of this key tenet of general practice. There is no doubt that over the last few years the demand on the health service has increased dramatically, and we do need to address that. But, being ignorant about the value of continuity of care has resulted in now only 27.2% of patients being able to see their own GP compared with 37.5% in 2012. So, while evidence seems to show that continuity of care improves outcomes, we seem to be travelling in the opposite direction in England.

This week’s conference of the LMCs in England features continuity of care across the agenda. The themed debate on the partnership model will ask some fundamental questions about the future of the model, which in effect is the discussion about the future of the profession.

General practice is changing and GPs are adept at dealing with that as demonstrated time and time again. But, I put to you, that whatever the policymakers decide about the future, the profession needs to stand firm and make it clear that general practice without continuity of care is not general practice at all.

Dr Krishna Kasaraneni is a GP in Yorkshire and BMA GP committee executive team member


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Readers' comments (10)

  • doctordog.

    What’s special about general practice?
    Patient convenience.

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  • The real world situation as gone beyond this we are drowning out here.Continuity is going the same way as a danish blue parrot thinking of monty python.

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  • Regurgitation of Royal College piffle.
    Never going to happen due to feminised workforce, part time working, Nocters, salaried workforce ad nauseam.
    And it will get worse.

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  • David Banner

    (Re Turn Out The Lights- surely you meant Norwegian?!)

    Bemoaning the loss of continuity of care is blaming the symptoms, not the disease.
    The insatiable drive to destroy small partnerships by every authority from the government down has the death of continuity of care as unavoidable collateral damage.
    Having swept those “expensive” pesky partners aside, the grand plan is to run primary care on noctors and short term part time salaried GPs, who won’t know you from Adam, but never mind, you won’t be seeing them again any way.

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  • National Hopeless Service

    Whats 'special' about General Practice; Block contracts and moral blackmail.

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  • My mistake getting older now I think danish blue was an old naughty movie, similar to GP land everyone gets screwed over for the benefit of others!

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  • I heartily agree with Krishna and there are a lot of us out there quietly getting on with providing good solid continuous care to families over decades. We are efficient as we know 40 minutes of history taking before they even sit down and can straight to the nub of the matter. Patients really appreciate this and it is being belittled by part time 'dabble doctors' who feel that they can do a vocational profession two days a week. They are steadily taking apart traditional general practice and helping do the governments wrecking work. Time to address the elephant in the room....

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  • Jonathan Heatley- plenty of full time partners doing an absolutely crap job because they are overworked and stressed beyond belief, stopped caring and just trying to survive to pension.
    I do GP part time which means, despite my incessant moaning on here, that I can actually quite enjoy it on the days I do it and like to think that makes me do a better job.

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  • Sadly as had been said in a previous Pulse article that continuity is only for the old and sick. Some of us older GPs value continuity as a useful clinical tool for all patients and which is valued very much by those patients.
    It would appear that likely younger doctors have lost a degree of vocation in medicine and think that continuity by the same practitioner amounts to ‘familiarity breeds contempt’. Of course we might miss something occasionally but ‘too many cooks’ doesn’t solve that. I do wonder if most patients are happy to see any doctor rather than their preferred clinician but then I am but an old school dinosaur in their eyes it would appear!

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  • The Govt. does not value GPs nor what they do.
    In NI, GP % share of NHS funds has fallen from around 12 in 2004 to 5.5 in 2017.
    Enough said. Market forces will decide if there are enough completely altruistic GPs to continue the service.

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