Opinion: continuity saves lives

Helen Salisbury, a GP, discusses the power of continuity of care

This is an edited version of an article that originally appeared on The BMJ 

A new research paper tells us (again) about the benefits of continuity of care. It shows that patients who stayed registered with the same GP over many years had fewer out-of-hours appointments and acute hospital admissions, as well as a reduced risk of death. These benefits were significant, and they increased the longer the relationship continued. In 2018, people who had kept the same GP for more than 15 years had a 25% lower chance of dying than those with a GP relationship lasting a year or less.

We spend a lot of our time prescribing medicine to reduce our patients’ risk of death, but few (if any) produce benefits this dramatic. What gives continuity of care this remarkable power? Patients who know and trust their doctors may be much more likely to follow their advice about preventive care and medical treatment. They may also be less reticent about discussing what’s really bothering them, as they trust their doctor to be responsive. 

As the doctor, it’s much easier to recognise when something is seriously wrong in patients you know; you can see as soon as they walk into the room that they have lost weight, are moving more slowly, or have a lower mood. This kind of personal knowledge is almost impossible to capture in medical notes.

There’s something special about the relationship built up between doctor and patient over many years. Familiarity changes the way you interact. Some of the patients I initially found the most difficult have mellowed – or begun to trust me – so that I now smile when I see their name on my appointment list, when once my heart would have sunk. We have, over the course of many consultations, worked out what we can expect from each other; I’ve stopped taking their grumpiness personally, and they’ve probably realised that I really am doing my best, even if we haven’t solved all of their problems.

The benefits are not all one way; the job of being a doctor is vastly more satisfying when you look after the same patients over a long period. In the higher echelons of the NHS, swift access to any practitioner seems to have trumped continuity of care and I was, therefore,heartened to hear from a newly qualified colleague that in a meeting where young salaried GPs were discussing how to improve their working lives, the opportunity to see a stable list of patients was their top priority.

“Continuity saves lives!” We should trumpet this from the rooftops – and if that doesn’t convince everyone, we should tell them that it also saves money. But take heed; in Norway, where the 2018 study was conducted, the average number of patients registered with each GP was 1,113, while in England a year later it was 2,087. It’s even higher now. 

Oslo, we have a problem.