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Is continuity all it’s cracked up to be?



Increasingly, our workforce is made up of a greater proportion of less than full time GPs. This is clearly an issue for practices, whose rotas were stable and straightforward for years when nine sessions was the norm.

Now, GPs in a practice may work anything from four sessions to full-time. Debates are had about workload, what constitutes a ‘half-day’, and whether working Mondays is a must.

But there is also a huge implication for patients: many don’t necessarily feel an allegiance to a particular practice, they just want to see ‘their’ GP. And when the delightful Dr Parte-Thyme doesn’t work on Tuesdays, Thursdays or Fridays, patients get grouchy and complaints start pouring in. Clearly, many still value patient-doctor continuity.

And GPs like continuity too: whilst we’re drowning in work, consultations with familiar patients can be hugely satisfying.

The recent work of Ridd et al. in the BJGP fuels the debate. Analysing data from the records of over 18,000 patients, the researchers evaluated whether patient-doctor continuity reduced the waiting time for patients from presenting symptom to diagnosis for breast, lung and colorectal cancers. The results may be surprising: seeing their favoured GP time and again will not win patients an early diagnosis.

If they have a high-risk symptom – breast lump, rectal bleeding, haemoptysis – they may as well see the miserable sod who everyone tries to avoid. The GP may never have met the patient previously, but is as likely to refer them as that delightful partner whose wine stores they regularly replenish.

For vague symptoms, the plot thickens. GPs who are familiar with a patient may attribute ‘tiredness’ or ‘fatigue’ to a personality trait or family issue. In knowing their patient well, it seems they may lose the gift of objectivity and a referral may be delayed. Presenting with the same symptom to a doctor with a fresh pair of eyes – perhaps a locum GP – actually expedites diagnoses in colorectal cancers by up to a week.

Now, a seven-day delay in a bowel cancer diagnosis is hardly a matter of life and death. On the contrary, though they’ve taken a slightly scenic route to the two-week clinic, patient satisfaction is still far higher in those who experience continuity of care from their GP.

Parties have offered all sorts of political policies in the most recent election: 8,000 new GPs, seven-day opening, same-day appointments for over-75s. All headline grabbing vote-winners, but all of them resulting in disjointed and discontinuous patient care.

We need to think seriously about our roles. Is doctor-patient continuity an antiquated has-been in a target-driven world where patient outcomes must take primacy?

Or, given the deep satisfaction both patients and GPs derive from continuity of care, despite moving to part-time working, do we need to make it an absolute priority?

A week is a long time in politics, but if your GP is worth their weight in gold, it may well be considered a small price to pay.

Dr Tom Gillham is a GP in Hertfordshire and specialty doctor in A&E. You can follow him @tjgillham.