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Patients don’t see the same GP any more – and that has to change Patients don’t see the same GP any more – and that has to change
(7 months later)
I recently did a surgery in my south London general practice. There were 18 patients at 10-minute intervals, followed by paperwork, results, prescriptions and a home visit. Nothing unusual in that.I recently did a surgery in my south London general practice. There were 18 patients at 10-minute intervals, followed by paperwork, results, prescriptions and a home visit. Nothing unusual in that.
But what was unusual was who I saw. Take for example Joan, now in her mid-70s. She has many health problems, including cancer, diabetes and depression. I first met Joan 25 years ago when she attended with her husband. I diagnosed his cancer of the colon. I cared for him during his terminal illness, and was with him when he died at home 12 months later. Philippa also came to see me for a postnatal check, accompanied by her mother, Clara. Both were so proud to be bringing in the new baby. I smiled as I remembered Clara, coming to see me for problems with conceiving so many years ago. I helped find the cause and shared her joy when she found out she was pregnant. That pregnancy was Philippa.But what was unusual was who I saw. Take for example Joan, now in her mid-70s. She has many health problems, including cancer, diabetes and depression. I first met Joan 25 years ago when she attended with her husband. I diagnosed his cancer of the colon. I cared for him during his terminal illness, and was with him when he died at home 12 months later. Philippa also came to see me for a postnatal check, accompanied by her mother, Clara. Both were so proud to be bringing in the new baby. I smiled as I remembered Clara, coming to see me for problems with conceiving so many years ago. I helped find the cause and shared her joy when she found out she was pregnant. That pregnancy was Philippa.
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We are fortunate to have had this experience. For 26 years I have worked in the same place. My consulting room is the same room, in the same building and with some of the same partners. Everything is familiar. Even the patients. I feel there is a special bond between patients I have cared for over this time and myself. I am their doctor, and they, in turn, are my patients. Joan, Philippa and Clara and I can look back at our shared experiences, of me bearing witness to their joyful and painful moments, and remember the ghosts of lost family members.We are fortunate to have had this experience. For 26 years I have worked in the same place. My consulting room is the same room, in the same building and with some of the same partners. Everything is familiar. Even the patients. I feel there is a special bond between patients I have cared for over this time and myself. I am their doctor, and they, in turn, are my patients. Joan, Philippa and Clara and I can look back at our shared experiences, of me bearing witness to their joyful and painful moments, and remember the ghosts of lost family members.
This continuity of care is valued by both patients and doctor. It allows GPs to build a rich tapestry of their patients’ lives, woven using the strands of contacts we have had together over years, within the context of their families and community. It allows us to deliver truly holistic care, drawing on what we know about our patients’ physical, psychological and social past. Consultations are easier and more productive.This continuity of care is valued by both patients and doctor. It allows GPs to build a rich tapestry of their patients’ lives, woven using the strands of contacts we have had together over years, within the context of their families and community. It allows us to deliver truly holistic care, drawing on what we know about our patients’ physical, psychological and social past. Consultations are easier and more productive.
Continuity of care is the single most important factor in delivering safe, cost-effective, and high quality care, with fewer errors. It results in cost savings in investigation, prescribing and hospital referrals and admissions.Continuity of care is the single most important factor in delivering safe, cost-effective, and high quality care, with fewer errors. It results in cost savings in investigation, prescribing and hospital referrals and admissions.
But a new study out this week confirms that continuity of care is largely disappearing. It has become a victim of the modern health service. There are many reasons for this. The pressure to offer increased access, the loss of personalised GP lists, the multiplicity of different providers (including new online GP services), the increased workload facing an overstretched workforce, and growing numbers of healthcare professionals working less than full time have all contributed.But a new study out this week confirms that continuity of care is largely disappearing. It has become a victim of the modern health service. There are many reasons for this. The pressure to offer increased access, the loss of personalised GP lists, the multiplicity of different providers (including new online GP services), the increased workload facing an overstretched workforce, and growing numbers of healthcare professionals working less than full time have all contributed.
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Of course timely access to care matters, but it should not come at the expense of continuity of care. Continuity of care does not necessarily mean always having to see your GP face-to-face – quite the contrary. Remote care over telephone, text, or e-consultations is safer where a trusting relationship has been established between doctor and patient.Of course timely access to care matters, but it should not come at the expense of continuity of care. Continuity of care does not necessarily mean always having to see your GP face-to-face – quite the contrary. Remote care over telephone, text, or e-consultations is safer where a trusting relationship has been established between doctor and patient.
GPs able to provide continuity of care to their patients and their communities should be at the very heart of the NHS. At a time where an ageing population means growing numbers of our patients are living with more long-term conditions, it is vital we find a way of redressing the loss of personalised, coordinated care. With enough GPs, we might be able to reverse the trend towards the quick fix – anyone, anytime.GPs able to provide continuity of care to their patients and their communities should be at the very heart of the NHS. At a time where an ageing population means growing numbers of our patients are living with more long-term conditions, it is vital we find a way of redressing the loss of personalised, coordinated care. With enough GPs, we might be able to reverse the trend towards the quick fix – anyone, anytime.
• Dr Clare Gerada is medical director of the Practitioner Health Programme and a former chair of the Royal College of General Practitioners• Dr Clare Gerada is medical director of the Practitioner Health Programme and a former chair of the Royal College of General Practitioners
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