One of the main reasons for an increasing general dissatisfaction with services in the NHS might be the lack of attention paid to values such as continuity and coordination. My concern is that, as general practice becomes more complex, things might go the same way in primary care. But there is a way – a better way – to avoid this.
As members of practice teams, we already appreciate the premium placed by patients on seeing professionals they know and trust. This has now been confirmed in new research led by Professor Richard Baker of the Department of Health Sciences at the University of Leicester, which I think will prove to be one of the most important studies of its kind to be published in recent years.(1)
More than 1,400 patients from West London and Leicestershire, aged between 18 and 80 years, from 22 practices and a walk-in centre, responded to a questionnaire about their preferences and experiences in primary care. They were asked about aspects of care relating to their most recent consultation, including:
- Interpersonal continuity – choosing a particular person; choosing someone known and trusted; and choosing someone who personally knows the patient and the patient’s medical condition.
- Being able to book an appointment in advance.
- The type of professional consulted – for example, choosing a nurse or a doctor; someone of the same sex; someone of the same ethnic group or culture; someone who would take time to listen.
- Information continuity – someone with paper or computer notes containing the full medical history of the patient.
The study confirms that patients place great value on having access to a GP or healthcare professional with whom they have built up a relationship. Interpersonal continuity was important to between 63% and 75% of patients, particularly those in poor health with routine problems.
The majority of patients also wanted to consult someone they perceived as taking the time to listen and who had information about their clinical history. More than 75% of patients said it was important to see someone who personally knew them and their medical condition, with 65% valuing the importance of a particular healthcare professional.
The study also highlights the need for practices to have flexible appointment systems to take into account the needs of people in work and those who have difficulty in negotiating the type of care they would like.
It gives us a modern framework for thinking about continuity and shows that services must be designed with this in mind. We need policies that reflect and support the value of interpersonal continuity – along with appointment systems in practices that allow patients to consult the person they know and trust.
I would urge all practice managers to make continuity – in its broadest, modern sense – a priority. Have a debate in your practice about the different types of continuity – personal, informational and clinical management. Let us have a return to values that really matter to patients and healthcare professionals.
- Baker R, Bankart J, Boulton M, Freeman GK, Tarrant C, Windridge K. Interpersonal continuity of care: a cross-sectional survey of primary care patients’ preferences and their experiences. Br J Gen Pract 2007;57(537):283-9.