GPs providing continuity of care must be NHS priority, says CMO

Allowing GPs to provide continuity of care should be a priority for the NHS, Scotland’s Chief Medical Officer (CMO) has argued in his latest report.

Professor Sir Gregor Smith, a GP and former medical director for primary care in NHS Lanarkshire, said that the NHS needs to recognise the ‘critical importance’ of continuity and relationship-based care delivered by GP practices.  

However, the RCGP warned that as the number of GPs in Scotland continues to decrease, increased pressure across general practice is ‘hampering’ GPs’ ability to deliver continuity of care.

Professor Smith pointed out that despite ‘clear benefits’ for the NHS and patients, there is less ‘relational continuity’, not only within general practice, but across Scotland, and that this needs to change.

In his annual report, he said that those who experience more ‘relational continuity’ with their GP are more likely to report higher levels of trust in their doctor, which has an important bearing on the quality and effectiveness of the care given.

He said: ‘As a GP, I had the privilege of relational continuity with the people I cared for and highly valued these relationships.

‘The human connection fostered through relational continuity is not only professionally satisfying but is simply vital, if we are to truly understand the sometimes complex needs of people we care for.

‘It is the polar opposite of industrialised, transactional care and not just a mechanism for healthcare delivery.’

Professor Smith said that there is ‘a growing body of evidence’ that continuity of care positively influences clinical outcomes for people across the life course.

He said: ‘GPs offering relational continuity identify more people at risk of cardiovascular events who will benefit from statins.

‘People living with diabetes have better glycaemic control when they have relational continuity with their health and care team.

‘In our older population, people living with dementia who have good relational continuity with their GP have been shown to have 10% fewer hospital admissions, 35% fewer episodes of delirium, and 57% less incontinence.’

He added that patients are more likely to follow advice from a professional they know, disclose their symptoms more readily and take medication as prescribed.

‘There is also evidence of significantly better uptake of personalised preventative medicine, such as screening for breast and cervical cancer and vaccinations,’ he added.

The report concluded: ‘Simply put, continuity, and relational continuity in particular, should not be regarded as “nice to do”. Nor can we say that we simply do not have the time.

‘The care we provide must be centred on what matters to the people we care for, not what matters to our system.

‘The evidence is clear, relational continuity is vital if we are to understand and deliver the outcomes that matter to the people we care for, use our resources more wisely and create a more sustainable system.’

In response to the report, RCGP Scotland chair Dr Chris Provan agreed that the benefits of continuity of care are ‘boundless’, not only for patients, but also for GPs and the wider health system.

He added: ‘Patients who receive strong relational continuity of care report higher levels of satisfaction, are more likely to adhere to medical advice, and have lower rates of hospital admissions.

‘GPs also benefit, with evidence showing reduced workloads as patients consult less frequently. Strong relationships and trust between practitioner and patient allow for the earlier disclosure of symptoms, faster diagnoses, and more effective treatment.’

But he pointed out that the number of whole time equivalent GPs in Scotland is continuing to decrease while patient need is rising, meaning that fewer GPs are able to deliver continuity of care.

He added: ‘RCGP Scotland’s most recent GP Voice Tracking survey found that less than half of GP respondents were able to deliver continuity of care which met their patients’ needs.

‘GPs are as frustrated as patients when there are issues with access. Fundamentally, it is the significant workload and workforce challenges that are the major barrier to good access.

‘Political emphasis on speed of access simply risks driving down appointment quality. It is crucial that those with urgent clinical needs are seen quickly, but we’d rather emphasise quality of access, as well as speed, so that more patients feel the benefits of relationship-based care with their long-standing clinician.

‘We continue to advocate for a comprehensive, long-term workforce strategy that will expand the capacity of general practice and enable the delivery of both timely and continuous care.’

Last year, a study suggested that continuity of care increases productivity in general practice by reducing demand for GP consultations. 

And researchers found GP continuity of care could reduce workload in practices and A&E, potentially freeing up appointments.

In England, practices will now be paid to identify those that ‘would benefit most from continuity of care’, via amendments to the Capacity and Access Improvement (CAIP) payment) announced as part of this years’ GP contract.

Earlier this year, a report found that Scotland’s Government failed to deliver on several of its 2018 commitments to support GP practices.