5-point plan to reinvigorate continuity of care for patients against a backdrop of GP pressures

The chair of the Royal College of GPs (RCGPs), Professor Martin Marshall, plans to set out a five-point plan to modernise and reinvigorate continuity of care for patients

Professor Marshall will give his keynote speech to more than 2,500 family doctors and primary healthcare professionals from 80 countries at the RCGP Annual Conference.

The chair will announce that building trusting relationships between GPs and patients is the most “powerful intervention” for delivering effective, high-quality care – and one that increases patient satisfaction, achieves better clinical outcomes, and reduces the use of hospital services.

However, he will highlight that continuity of care is becoming increasingly difficult to deliver, given the intense workload and workforce pressures facing GPs and their teams – the “most worrying crisis in decades”. He’ll say that the challenges that GPs face in having time to really get to know their patients pose an “existential threat” to patient care and to the future of general practice in the UK.

Last week the College revealed that 68% of GPs and GP trainees say they don’t have enough time to properly assess their patients, with 65% saying patient safety is being compromised due to appointments being too short, according to a recent survey of more than 1,200 members. The same survey found that only 39% of respondents said they were able to deliver the relational continuity or relationship-based care their patients need – down from 60% just two years ago.

Professor Marshall will outline five changes necessary to make relationship-based care and continuity of care feel relevant to patients, deliverable by clinicians and seen as essential by health service leaders and policy makers.

He will say that:

1. Building the GP-patient relationship requires time and space but GPs are working well beyond capacity and GP consultations are currently the second shortest in Europe, with an of average three problems presented in a standard 10-minute consultation. 
2. The importance of relationship-based care needs to be made “more explicit and less mysterious” for policy makers and system leaders. “Politicians may never understand our passionate commitment to continuity but they will understand the hard-headed language of ‘value’ – better outcomes at lower cost, which is what good continuity has been shown to deliver.”
3. Whilst the traditional model of building the GP-patient relationship over many years remains the “gold-standard” of relationship-based care, it is possible for well-trained clinicians to build trust over a much shorter period of time. ‘Speed relationships’ – connections that can be made with patients even in a single consultation – should reassure GPs that at least some of the benefits of relationship-based care can still be achieved.
4. More research needs to be undertaken to establish a greater understanding of establishing and maintaining patient relationships when delivering care remotely, given that evidence in this area predates the COVID pandemic, during which digital interactions between patients and clinicians have become more substantive and more sophisticated.
5. There needs to be better understanding that continuity of care can be delivered but not necessarily in the way it has been in the past, particularly given the increasing number of other healthcare professionals now working as part of general practice teams. “Continuity of care is a defining feature of family practice but doctors shouldn’t have a monopoly on its delivery,” he will say, citing good examples where good patient relationships are held by more than one clinician.

His speech comes as the RCGP publishes a new report Relationship-based care: fit for the future that explores the change levers that can embed and strengthen the relational elements of care within the modern general practice landscape. It makes a number of key recommendations including on workforce and workload, the ways technology can support continuity of care, and the ways relationship-based care can be measured and incentivised.

Reflecting on his own experiences at his practice in Newham, East London, Prof Marshall will say: 

“Patients really benefit from the simple fact that their family doctor has got to know them over time and has built mutual trust, and this is supported by a body of research evidence conducted over many decades in many different countries.”