Continuity of care has long been one of the boasts of the RCGP, but with part time working, overburdened GPs , retirement, emigration and career changes, the objective has been one in name rather than reality. There are too few GPs who undertake terminal care, and it is only in the Hebrides that the same hands deliver you as those that close your eyes on death. It is particularly helpful with older patients, and bringing them to terms with the reality of a final illness…
Seeing only one family doctor cuts the risk of dying early by up to 53 per cent, an international analysis has found.
Having repeated appointments with the same GP was as effective at reducing death rates as some drugs, according to an overview of 22 studies.
Sir Denis Pereira Gray, who led the work, said NHS policy needed a “complete change” to recognise the value of a personal relationship with a family doctor, rather than diverting GPs from their regular patients to provide evening and weekend appointments.
“If you can build a worthwhile relationship with a doctor it will be to your advantage and theirs over time,” he advised patients.
Four fifths of the studies covered in the research showed that continuity of care had clear benefits over periods ranging from a weekend in hospital to 17 years. Previous work has shown that patients who see the same doctor regularly are more satisfied and less likely to go to A&E, but Sir Denis argued that health chiefs should stop seeing this continuity as a luxury “like a nicely decorated room”.
He said: “Arranging for patients to see the doctor of their choice has been considered a matter of convenience or courtesy: now it is clear it is about the quality of medical practice and is literally a matter of life and death.”
A study last month found that only half of NHS patients were able to see their preferred GP most of the time, down from two thirds five years ago.
Sir Denis, a former head of the Royal College of GPs and the Academy of Medical Royal Colleges, argued that “if a patient knows and likes a doctor, they are more open to giving more information and things they are worried about that they would be less likely to divulge to a strange doctor”.
Not only does this make a doctor’s diagnosis better and their advice more personalised but, he argued, “patients who have the same doctor are also more likely to follow the doctor’s advice”. Older people were particularly likely to benefit from a personal relationship with their GP, he added.
Sir Denis’s paper is the first to bring together international evidence from nine countries, including Britain, about the relationship between regular appointments with the same doctors and death rates. All the studies pointed in the same direction with one showing a 53 per cent reduction in death rates. The size of the benefit was “in the same range as some treatment effects”, his team wrote in the journal BMJ Open.
Sir Denis said that at the St Leonard’s Practice in Exeter, where he works, 51 per cent of patients see the same GP every time.
However, Kamila Hawthorne, vice-chairwoman of the Royal College of GPs, said: “General practice is facing intense resource and workforce pressures . . . unfortunately, waiting to see ‘their’ GP means patients may have to wait even longer for an appointment.”
The Department of Health insisted that over-75s had a single GP accountable for their care. A spokesman said an extra £2.4 billion a year was being invested to improve access to patients and availability of appointments.
Sir, The study led by Sir Denis Pereira Gray does not demonstrate that “seeing the same family doctor cuts the risk of dying early by up to 53 per cent” (report, June 29). It found evidence that seeing the same family doctor is associated with an up to
53 per cent lower risk of early death. Association is not causation.
Healthier people are at reduced risk of early death, and they are more likely to be able to wait to see their own doctor. Those who are more ill need to see whoever is available at the earliest opportunity. Perhaps articulate and motivated people work the system better in order to see the doctor of their choice, and they may be at reduced risk of early death for many reasons.
I, too, think continuity of care is a good thing and am sad that we are losing it. It may indeed prevent premature death — but the evidence presented does not show that.
Dr Simon Dover
Sir, The only surprise about news that seeing the same GP is beneficial is that it took 22 studies to establish the fact. It must be more efficient, apart from cementing trust between doctor and patient. Many routine questions and answers will not be necessary after the first visit, whereas fresh doctors have to establish some of this information for themselves.
We are told that older people are particularly likely to benefit from a personal relationship, and they are the ones who take up most time at any surgery. They will not be the patients demanding evening and weekend appointments.