Missing by omission: the hidden heart of cardiovascular inequity in the UK

Clare R Goyder; Caroline Mitchell; Charlotte James; Oshin Sharma; Ben Lacey; Nigel David Hart; Emily McFadden; Joseph J Lee; Yeyenta Osasu; Pensee Wu; Kathryn S Taylor; John Ford

doi:10.3399/BJGP.2025.0701

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Missingness is a sub set of discontinuity
Denis Pereira Gray, Kate Sidaway-Lee and Philip H Evans

Published on: 27 May 2026

Published on: (27 May 2026)
Page navigation anchor for Missingness is a sub set of discontinuity
Missingness is a sub set of discontinuity
Denis Pereira Gray, Consultant, St Leonard's Research Practice, Exeter
Other Contributors:
Kate Sidaway-Lee, Research Fellow, St Leonard's Research Practice

Philip H Evans, Consultant, St Leonard's Research Practice
The article on missingness¹ is timely in well emphasising the importance of missingness. The authors rightfully referred to the inspiring achievement of Tudor Hart (1975)² who measured the blood pressure of every one of his patients. He did this because he had a personal list and knew his patients personally. That work is a textbook example of how personal lists, in addition to improving GP continuity, also help GPs to gain a sense of responsibility for their list of patients.

Goyder et al.’s article has a limitation in not mentioning in the text or the references the link with discontinuity when missingness is a subset of discontinuity. Sweeney et al. (1995)³ described discontinuity and first suggested that patients who did not receive GP continuity might be a vulnerable group. Goyder et al. support that.

The theory of general practice has developed greatly but we owe it to our students and GP registrars, not to present GP theory in multiple, isolated silos, as this makes it more difficult for them to realize that one of the great strengths of general practice is its integrating function.⁴

A further practical reason for emphasising these cross-links is that it is likely that one of the best ways of reducing the serious impact of missingness will be by regaining continuity of GP care. Missingness was not a problem in Tudor Hart’s practice.

References

1. Goyder C...
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The article on missingness¹ is timely in well emphasising the importance of missingness. The authors rightfully referred to the inspiring achievement of Tudor Hart (1975)² who measured the blood pressure of every one of his patients. He did this because he had a personal list and knew his patients personally. That work is a textbook example of how personal lists, in addition to improving GP continuity, also help GPs to gain a sense of responsibility for their list of patients.

Goyder et al.’s article has a limitation in not mentioning in the text or the references the link with discontinuity when missingness is a subset of discontinuity. Sweeney et al. (1995)³ described discontinuity and first suggested that patients who did not receive GP continuity might be a vulnerable group. Goyder et al. support that.

The theory of general practice has developed greatly but we owe it to our students and GP registrars, not to present GP theory in multiple, isolated silos, as this makes it more difficult for them to realize that one of the great strengths of general practice is its integrating function.⁴

A further practical reason for emphasising these cross-links is that it is likely that one of the best ways of reducing the serious impact of missingness will be by regaining continuity of GP care. Missingness was not a problem in Tudor Hart’s practice.

References

1. Goyder CR Mitchell C James C et al. Missingness by omission: the hidden heart of cardiovascular inequity in the UK. Br J Gen Pract 2026; 76(766): 229-232
2. Tudor Hart J. The management of high blood pressure in general practice. J R Coll Gen Practitioners; 1975; 25:160-192
3. Sweeney, K.G. and Pereira Gray, D Patients who do not receive continuity of care from their general practitioner--are they a vulnerable group? Br J Gen Pract 1995; 45(392):133.
4. Pereira Gray D. General practice—the integrating discipline. Br J Gen Pract 2023; 73(734): vf388-9.
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Competing Interests: None declared.

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