The very clear result is that GPs have real concerns about their ability to provide continuity of care, with more than 60 per cent of GPs surveyed saying that care continuity would be their top priority for improvement. The responses revealed that many would like to spend more time with their patients, and that other dimensions of quality – such as faster access to care – should become a lower priority.
A growing complexity of need, ever-widening range of services and the sheer volume of patient contacts each day have added to a sense that traditional general practice is 'like too little butter spread over too much bread' and that continuity of care is the inevitable casualty of this process. The survey results support this.
There are other forces at play too. Contractual incentives, such as the Quality and Outcomes Framework, reward 'clinical' activity and drive the profession towards a disease-based model of care. The harder-to-measure 'psycho-social' aspects of care quality become undervalued, which in turn makes it harder to treat the whole person. Access targets in general practice have also undermined the ability of many patients to see the doctor of their choice at a time that is convenient to them. As a result, international studies show the UK doesn't rate well in terms of patients being able to see the doctor they want and being involved in their own care.
Of course, continuity of care is only one dimension of care quality – but is it something that we should be prepared to sacrifice? The answer should be a definite no.
Improving care continuity in a way that engages patients in the management of their own care can be associated with higher patient satisfaction, improved independence at home, and lower rates of hospitalisation. Given that the future demands on general practice (and the NHS more generally) will be driven by the needs of older people and those with complex long-term care needs, continuity of care becomes a pre-requisite of the way care is provided.
Preserving continuity of care within general practice is important, but co-ordinated care between general practice and other care providers is also essential for patients. The artificial barriers between general practice, community providers, social care teams and hospital specialists need to be broken. After all, the value of care continuity is as much about ensuring someone's care is managed effectively as it is about developing the doctor-patient relationship.
Read the full results of the survey – the final report for The King's Fund's Inquiry into the Quality of General Practice in England, undertaken by an independent panel, will be published in the new year.