Dr Benett is right that access and continuity are interlinked and we agree that general practice needs investment in capacity.1
However, it is disappointing to see a clinical director of a CCG writing that there is only ‘equivocal evidence on the relationship between continuity and patient outcomes’. It is revealing that he uses Harold Shipman as evidence against continuity of care in a scientific journal.
With the doctor–patient relationship being as strong as it is, some adverse effects are inevitable. The ‘heartsink’ phenomenon is one2 and there are a small number of studies suggesting delayed cancer diagnosis.3 Collusion is a problem in all clinical practice and may be associated with continuity of care in general practice.
However, these adverse findings have all been countered, so that the same Rogers et al article3 also showed that increased trust in the doctor improved cancer detection, and trust in the doctor is itself associated with continuity of general practice care,4 while O’Connor et al showed that a regular provider was associated with significantly improved diabetes care.5
Directors of CCGs should know of the three really big gains in outcomes from continuity of care all of which matter to the whole NHS: increased patient satisfaction, better uptake of evidence-based preventive care, and, as research from Canada,6 Norway, the UK, and the US, consistently shows, fewer emergency admissions to hospital. Dr Benett’s CCG is currently paying £1844 for each emergency hospital admission.
- © British Journal of General Practice 2014