TY - JOUR T1 - Interpersonal continuity: old and new perspectives JF - British Journal of General Practice JO - Br J Gen Pract SP - 527 LP - 529 VL - 57 IS - 540 AU - Barbara Starfield AU - John Horder Y1 - 2007/07/01 UR - http://bjgp.org/content/57/540/527.abstract N2 - There is a wide perception that British general practice is being compromised.1 As it has been ‘the envy of most of the western world’,2 this is of concern. The new General Medical Services (GMS) contract offers and emphasises supplemental reimbursements that are limited to the provision of measurable clinical services. Are NHS quality efforts aiming to improving care consistent with its commitment to a ‘primary care centred’ health service? To answer this question, we draw on evidence of the benefits of a primary care-led health system, explore aspects of primary care responsible for its benefits, and discuss how current efforts in the US and the UK threaten the achievements of primary care.We turn first to the experience in the US, where there are large variations in the provision of primary care and where there are large associated variations in mortality and in other measures of outcome. Mortality in the US is lowest in states where there is a greater proportion of primary care doctors3 and for individuals reporting a generalist rather than a specialist as their personal doctor.4Hospitalisation rates are inversely associated with access to primary care doctors and to their numbers.5,6 Areas with better primary care resources have higher life expectancies and lower all-cause mortality and mortality from the major causes of death, even after controlling for income inequality and major sociodemographic characteristics associated with health. Areas with better primary care services also have fewer disparities in health between socially advantaged and socially disadvantaged population groups.7 Among industrialised countries, the US has one of the most highly specialised health systems, with very poor and declining primary care infrastructure.8,9The benefits of primary care are attributable to several mechanisms: Availability of more primary care physicians (but not … ER -