The Royal College of General Practitioners seems to wish to promote continuity over accessibility.1 However, continuity and access are not mutually exclusive. Sometimes patients or parents have to make a trade-off between speed of appointment and choice of doctor. Those with a new problem, children, and those who work, prefer speed. Those with longstanding physical illness, women, and older people, prefer their own doctor. In any case, establishing and maintaining a relationship with a clinician depends on having ready access to them.
There is only equivocal evidence on the relationship between continuity and patient outcomes.2 Seeing the same doctor does not guarantee a good relationship! Dr Harold Shipman is a well-known example of how things can go very wrong. Indeed a particular risk of continuity is of collusion, for example in sickness certification or of perpetuating pathological behaviours.3 On balance, the benefits of relationship continuity appear to be better supported by research than the risks. On the other hand, generally speaking, practices that perform well on delivering a good experience for their patients also perform well on measures of clinical quality.4 Better access consistently showed the strongest link with the process and outcome indicators of quality.
One study found that better access to primary care was correlated with higher QOF scores, and lower rates of emergency admission,5 and another with lower emergency department utilisation.6 Another study found delayed first diagnosis of cancer7 with poor access.
The debate should no longer be about either access or continuity, but how both are delivered. This will involve investment in primary care capacity and capability, as we have done in Central Manchester.
- © British Journal of General Practice 2014