By Craig Kenny
Continuity of care has suffered because of reforms in general practice in recent years, notably the 2004 GPs' contract and the demand for 48-hour access, concludes a report by the RCGP.
While patients prefer a relationship with an individual doctor, changes in the way primary care are delivered have made this harder to achieve, says the paper, written by GP Allison Hill and Professor George Freeman of Imperial College.
Since 2004 patient lists belong to the practice, rather than the individual GP, they note. ‘Registration does not offer patients any kind of link with an individual doctor. Any subsequent choice the patient is able to make is seldom recorded. This sends a message that personal relationships are not valued.'
Also, the lifting of responsibility for out-of-hours care, and the spread of salaried GPs and locums makes seeing a preferred GP more difficult. ‘In many practices it requires enterprise, determination and social skill to get to see your chosen doctor.
Target-setting has also impacted on the doctor-patient relationship. In particular the QOF's reward of selected clinical priorities at the expense of others can undermine a ‘holistic' approach to care.
‘GPs relied on their store of patient trust to persuade patients to attend extra health checks and this has frustrated some doctors (and patients), and threatens to damage the goodwill of some in the longer term,' the authors argue.
They conclude: ‘The cumulative effect of policy developments on relationship continuity has started to show a "step-change" reduction in continuity perceived by patients after introduction of the 2004 contract, which has not recovered.'
RCGP Chair Dr Clare Gerada commented: ‘The days of the traditional family doctor may be over, thanks to societal and professional developments, but the need for relationship and management continuity is more important than ever; clinicians face the dual challenge of an increasingly ageing population presenting multiple co-morbidities.'
Promoting Continuity of Care in General Practice (RCGP 2011)
Dr Clare Gerada
