Dear Editors
Like Dr Salisbury, I value the idea of continuity of care for long term patients.
I wonder however if she has any solution to be able to provide this kind of care when modern working arrangements mean reduced face-to-face clinical session with patients (hence less available to patients) and the idea that patients are “shared” within a practice group with the assumption that the same relationship, personal perspectives, treatment/communication style can be found amongst the doctors without the “nominated” doctor providing the majority of the care*.
* some studies looking at the value of a designated or nominated GP failed to find “improvements in either continuity of care or rates of unplanned hospitalisation” (ref 1), but it is uncertain if sufficient patients were adequately informed who their named GP was at the time of the trial, nor did the study look at whether the named GP ended up providing most of the care rather than just an administrative lip-service; other studies provide too short a followup time (9 months – ref 2) for any reasonable person to expect benefit from continuity of care
Seeing patients from birth to most of their adult life can still be possible in a rural practice but increasing movement of people, and migrating households in response to economic/ work/ social factors, mean that expecting long-term continuity of care may be the exception rather than the norm.
While it is not possible to occur in the NHS’s capitation based on target population identified by geography, some patients in Australia would much rather travel longer and further to see their preferred (favourite) GP rather than to try looking for another GP in the area they moved into. My fondest memory as a medical student in the early 1990s of a valued doctor in public medicine is seeing an elderly patient who took 1 bus ride, 2 train trips and a 15 minutes walk on a busy street just to see their preferred GP they had been seeing for the last 20 years, who had been charging a small fee* on top of the Medicare rebate (under-)funded by the government.
* the GP couldn’t bear to raise this fee in step with inflation, knowing the patient would have paid about 15 dollars for the return trip even with the pensioner’s discount
That is the true worth of a valued doctor in the eyes of the patient. Not how much the doctor complied with the NHS guidelines or NICE recommendation. Not whether the doctor completed the continuing development program in accordance with the medical college. Nor whether the doctor performed a reflective review of the practice and if there is any complaint or compliance issue as determined by the GMC.
The relationship between the doctor and the patient has changed significantly in essence over the last 70 years under the NHS, from a therapeutic-advocacy relationship funded by the NHS, to a commercial-like provider-consumer connection which is dictated and measured by the NHS and the GMC (indirectly through its actions) and where the decisions are driven by fear and compliance rather than genuine care and in partnership with the patient.
Reference
1. http://dx.doi.org/10.1136/bmjopen-2019-029103
2. http://dx.doi.org/10.1136/bmjopen-2016-011422
Continuity of care as the worth of a GP, and a doctor