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The case for continuity



When I was a child, growing up in Southend in the 70s, one of my most enduring memories was of our family doctor. Dr F was a short, rotund character, rather like Norman Rockwell’s caricature in the ‘Doctor and the Doll’. He was clearly unhinged by the arrival of my parents and their nine young children, and even during those formative years, I could see the funny side of him telling us we were ill because we had not got used to the weather in this country yet. But in spite of his lack of worldliness and some quite spectacular medical errors, he was kind and held my mother’s hand after my father died. As he was single handed, he was the only doctor I ever saw until the age of 18 when I left home.

We are obviously not living in the 70s now but in a 24/7 world of impatience and instant gratification. My local Mall is now open until 10pm daily in the run up to Christmas and if I can go and buy my socks at 9pm, why can’t I also get my smear done then? Successive governments have fuelled this choice-led agenda and the irony is that those with the most health needs have had their choices restricted, with the bureaucratic issues of choose and book and inability to attend a practice during extended hours due to transport issues.

The government’s drive for round the clock routine primary care is detrimental to continuity of care. If my sanity only allows me to work six or seven sessions at the coalface and these sessions have to be spread over twelve hour days for seven days a week, how am I possibly going to develop a close relationship with patients who have multiple and often complex health needs?

The key to reducing unscheduled urgent care is to have continuity of in-hours care. The chaotic drug dependent diabetic, the personality disorder who frequently self-harms, the brittle asthmatic… how will some of these patients fare in a supermarket-style practice?

Instead of spending £50m on wider GP access, the Government should be investing in partnerships in smaller practices to allow them to deliver the type of service that doctors want and patients need.

We need to integrate IT systems with out of hours to allow continuity of care, whilst rejecting the consumerist agenda for health, to encourage continuity of care in core hours. It is this relationship with the patient that will reduce referrals and unscheduled admissions; not the pandering to the chattering classes. Unfortunately, as health is a political hot potato, the chattering classes will always win.

Dr Shaba Nabi is a GP trainer in Bristol