A milestone review examining 1.4 million patients worldwide found that those who do not see the same doctor regularly are more likely to die within a certain period. This consistent relationship with a doctor is known as “continuity of care”.
Many of the benefits of this approach probably stem from the fact that doctors accumulate knowledge about an individual patient, which they then use in subsequent consultations to tailor advice.
However, despite strong evidence that continuity of care is one of the most cost-effective strategies in medical practice today, it is declining significantly in both the UK and the US.
There is plenty of evidence that continuity of care has many benefits besides reducing the risk of death. For example, if you see the same doctor on each visit, you will have a lower risk of being admitted to hospital or of having to go to an emergency department. You will also have a better relationship with your doctor and be prescribed the most appropriate medication (and stick to your prescribed medication).
And these benefits are seen across almost all common health conditions, including dementia, diabetes, heart disease and mental illness, and across different patient groups, such as older patients and children.
For those with dementia – nearly 1 million people in Britain – the benefits of seeing the same doctor, at the clinic or at home, are particularly good. In a 2022 study, it was found that those who saw the same doctor, compared with those who saw lots of different GPs, were 35% less likely to develop delirium, 57% less likely to develop incontinence and 10% less likely to be admitted to hospital as an emergency.
These are important differences – it must be borne in mind that patients rarely only have dementia. Of those over 65 and diagnosed with dementia, 65% will also have high blood pressure, 34% depression, 27% heart disease and 22% diabetes.
Why is continuity of care declining? There are numerous explanations. Patients and doctors are increasingly mobile, solo GP practice is becoming rare, the number of patients with chronic diseases is rising, family doctors are increasingly in large group practices, and on-call services are increasingly organised on a large scale. But the real killer? Patients and administrators prefer to prioritise access over continuity.
What can be done about it? Remedies to the decline are surprisingly uncomplicated. It can be measured and there are proven mechanisms to improve it, not least the use of GP “personal lists” (a list of patients that just one GP sees) and re-emphasising continuity of care as a priority. In other words, changing professional attitudes and behaviour in primary care.
Fixing the polypharmacy problem
But perhaps the biggest benefit to continuity of care is that personal, single-GP care results in widescale “deprescribing”, that is, stopping medication that might be causing harm or might no longer be of benefit.
Polypharmacy (taking several drugs due to over-prescribing and inappropriate prescribing) is widespread. It is hugely expensive and results in harm...