Beyond relational continuity

We thank Dr Burch¹ for his interest in our article and agree that the distinction between longitudinal and relational continuity is important.

We are pleased that he too thinks that “relational continuity for patients in primary care….should be maximised wherever possible.” He is correct that others have included information and management continuity in the broad concept of continuity of general practitioner care. However, we prefer to separate these and believe that informational continuity is essentially good record-keeping and management continuity good practice and care plans. Of course, both of these are desirable but our article concerned “relational continuity.”

The patients’ perception of having a deep (trusting) relationship with their GP has been reported by Ridd et al. (2011)² linked to the number of consultations had with that GP. It shows a linear increase in the depth of the relationship up to eight consultations when there is a 50% probability of patients thinking they have a “deep” relationship with the GP concerned. We continue to think relational continuity is by far the most important part of continuity and is the main mechanism generating the important outcomes.³ It needs further study in a RCT of an intervention to improve continuity.

We do not follow his point about general practice “as it is rather than how we would like to be”, as we very much study general practice as it is. Our earlier report⁴ Sidaway-Lee et al. (2019) reported the measured continuity in a group general practice with 9,000 patients over two years that was actually received by patients; 65% of all appointments made by patients aged 65 or over were with their personal GP despite all the GPs being part-time. Since then, we have learned of other practices where measured continuity of GP care is higher, and we have recently reported how it is also high in two other European countries.⁵

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